1845. Implementing Outpatient Antimicrobial Stewardship in a Primary Care Office Through Pharmacist-led Audit and Feedback

Abstract

BackgroundMore than 30% of antibiotics prescribed in the outpatient setting are unnecessary. This study aimed to determine the impact of pharmacist-led audit and feedback on outpatient antibiotic prescribing for upper respiratory tract infections (URIs) and urinary tract infections (UTIs).MethodsA retrospective, observational study was conducted at an outpatient primary care office to evaluate implementation of a pharmacist-led audit and feedback process. The office includes 0.6 FTE ambulatory care pharmacist (ACP) who completed antimicrobial stewardship training, and is part of a health system supported by a pharmacist and physician co-led antimicrobial stewardship program (ASP). Education, including pocket cards with URI and UTI guidelines was provided by the ASP leads in July 2017 prior to the study period (August 2017–March 2018). The ACP was responsible for weekly audit of all prescribed antibiotics for URI and UTI and provided feedback to prescribers. Appropriateness of therapy was determined via the guidelines presented by the ASP team. Feedback included recommendations regarding watch-and-wait, antimicrobial selection, dose, and duration of therapy. The primary outcome was to compare antibiotic use over time following the implementation of the audit and feedback program.ResultsOver the study period 1,107 prescriptions were audited by the ACP: 825 URI and 282 UTI. Feedback was provided for all cases, positive feedback for 580 (52.4%), negative feedback for 380, (34.3%) and mixed feedback for 147 (13.3%). The most common reasons for feedback were inappropriate agent (26.3%) and too long of duration of therapy (24.3%). Fluoroquinolone prescribing rates for UTIs decreased from 85% at baseline to 40% in Month 1 and to 11.7% of UTI prescriptions over the next 6 months. Nitrofurantoin prescribing increased from 0.4% in Month 1 to 38.6% of UTI prescriptions over the next 6 months to become the most commonly prescribed agent. Β-lactams were the most commonly prescribed antibiotics for URIs (66.7%). The median URI duration of therapy decreased from 10 days at baseline to 7 days across all 7 study months.ConclusionPharmacist-led audit and feedback significantly reduced fluoroquinolone prescribing for UTIs and shortened median duration of therapy for URIs in the outpatient setting.Disclosures All authors: No reported disclosures.