1122. Implementation of an Outpatient Antimicrobial Stewardship Program within a Pediatric Health System

Abstract

BackgroundOver 60% of antibiotic expenditures occur in outpatient settings with at least 30% being unnecessary. In 2016, the Centers for Disease Control and Prevention (CDC) defined core elements for outpatient antimicrobial stewardship programs (ASP): commitment from all members of the healthcare team, action for policy and practice, tracking and reporting, and education and expertise. Quantifying local prescribing practices and frontline provider engagement are essential for successful outpatient ASP. We describe our outpatient ASP efforts at Children’s Mercy Kansas City (CM) emergency departments (ED) and urgent care clinics (UCC).MethodsIn March 2018, we created a report defining antibiotic prescribing patterns in 16 common pediatric infections using ICD-10 codes from ED and UCC encounters. Baseline data helped identify areas for targeted interventions and establish ED/UCC engagement, which we have maintained by ongoing review and sharing of data with leadership and frontline providers.ResultsBaseline data showed low antibiotic prescribing rates (<5%) for most viral infections, except a rate of 74% in otitis media with effusion (OME) (Figure 1). We also identified a higher rate of cefdinir use in acute otitis media (AOM), community-acquired pneumonia, and urinary tract infections (Figure 2). We developed and shared an outpatient antibiotic handbook facilitating diagnosis and treatment of common infections. Ongoing QI teams are focusing on increasing utilization of safety-net antibiotic prescriptions for eligible patients with AOM in EDs, decreasing antibiotic prescriptions of OME, and decreasing unnecessary rapid streptococcal testing in UCCs. Through these multiple interventions, in addition to email communications and newsletter articles, we observed early improvements in prescribing patterns, including OME antibiotic prescriptions and cefdinir use (Figures 1 and 2).ConclusionWe used the CDC’s core elements for outpatient ASP to successfully develop interventions in our EDs and UCCs. We created a report defining baseline prescribing patterns and identifying opportunities for improvement. Data sharing with leadership and frontline providers facilitated widespread engagement in ASP efforts. Disclosures All authors: No reported disclosures