47. Assessing Viability and Outcomes following the Redistribution of Antibiotic Stewardship Tasks to the Clinical Pharmacist Team

BACKGROUND: Methodist Hospital and Cardinal Health determined that the TJC-mandated ASP program could be further improved. In February 2018, the program was restructured and ASP responsibilities were extended to all Clinical Pharmacists. Changing the ASP structure can improve the program efficiency via increased number of interventions/day, antibiotics’ days of therapy (DOT)/1000 patient-days, total antibiotics’ cost, and antibiotics’ cost/patient day. METHODS: A retrospective review was conducted for before and after data. The primary endpoints included number of ASP interventions/day, antibiotics DOT, and antibiotics’ cost/adjusted patient day. The secondary endpoints included effect on resistance of antibiotics for Pseudomonas aeruginosa, 48-hours antibiotic stop review, number of cultures reviewed, 7-days antibiotics review, and restricted antibiotics review. Reports were obtained from Cardinal Health’s Drug Cost Opportunity Analytics program and Electronic Medical Record (EMR). Intervention types analyzed included: de-escalation, 48-hours review, 7-days review, cultures review, and restricted antibiotics review. Efficiency between pre and post implementation was compared via adjusted interventions/day. Resistance pattern of Pseudomonas aeruginosa, was also trended. Interventions were trended and mean/day (SD) was calculated using Wilcox Rank Sum Test. RESULTS: The results showed improved efficiency with ASP interventions/day of 9.87 versus 4.73 (P≤0.0001). The DOT/1000 PD decreased from 1098 to 989 days. Antibiotics’ costs/adjusted patient day reduced from $16.62 to $9.16. For secondary endpoints: improvement in sensitivity of different antibiotics for P.aeruginosa was noticed. Increased 48-hours antibiotic stop review (2 vs 722), increased number of cultures reviewed (380 vs 518), increased 7-days antibiotics review (24 vs 78), and increased restricted antibiotics (142 vs 432) were observed. CONCLUSION: Transforming the ASP program at MHSC with Cardinal Health from resulted in improved efficiency, increased number of ASP-related interventions/day, decreased antibiotics DOT, decreased antibiotics-related cost/patient day, and increased sensitivities of drugs against Pseudomonas aeruginosa. DISCLOSURES: Stephanie L. Do, PharmD, Cardinal Health (Employee) Saboor Shahzad, BS. PharmD, Cardinal Health (Employee) Terence Lok, PharMD, MS, Cardinal Health (Employee) Hye Hyun An, PharMD Candidate 2022, Cardinal Health (Employee) Suzanna Arnone, PharMD, Cardinal Health (Employee)