1032. Impact of an Antimicrobial Stewardship Team-Led Initiative – Assessment of Therapy Appropriateness at Patient Discharge

Abstract

Background. Current focus and emphasis on managed care have encouraged the practice of discharging patients admitted for infections as soon as possible which in-turn has increased the likelihood of patients being discharged on antimicrobials once the acute infection is under control. Many programs have demonstrated success of antimicrobial stewardship (AMS) initiatives but there is little in the published literature surrounding transitional care AMS. Methods. Patients admitted to University of Maryland Prince George's Hospital who were to be discharged on antimicrobials within 24 hours were identified during multidisciplinary patient rounds over a 2-phase period (each 3 weeks long). Rounds were attended by the AMS team composed of Post-Graduate Year 1 pharmacy residents and/or the AMS pharmacist and/or the AMS physician. Both the choice of antimicrobial and total treatment days including post-discharge days were evaluated and interventions were made based on adherence to current published guidelines. If antimicrobial selection or treatment duration appeared to be inconsistent with guidelines, the case was discussed with the prescriber and agreed-upon changes made prior to the patient's discharge. Accepted and denied recommendations were documented. Patients were also educated on indications, directions and side effects of their antimicrobials. Results. The AMS team evaluated patients for selected antimicrobial drug and duration of outpatient treatment over the 2-phase period with 20 patients in phase 1 and 26 patients in phase 2. Interventions needed to be made for 100% of patients in phase 1 but only for 50% of patients in phase 2. Duration of treatment was the only intervention which needed to be made with 85% of the interventions in phase 1 accepted and 85% in phase 2. The most common indications for treatment are represented in Figure 1. The average decrease in treatment duration for phase 1 and 2 was 3.6 days and 2.8 days respectively. Conclusion. These findings suggest that discharge AMS initiatives can decrease patients' overall antimicrobial exposure and potential adverse events, educate providers on treatment guidelines especially of common disease states, increase overall provider compliance with evidence-based literature, and ascertain the appropriateness of therapy choices. (Figure Presented).