193. Duration of Antimicrobial Therapy: The Impact of Defaults

Abstract

BackgroundDefault durations imbedded in the electronic prescription (e-script) order entry process may be interpreted by providers as duration recommendations. This process could lead to inappropriately long durations of therapy for antibiotics, especially at hospital discharge when patients have received inpatient antibiotics.MethodsDefault durations of 7 or 10 days for fluoroquinolones (FQ) were removed from inpatient and outpatient e-scripts from Duke University Health System (DUHS) hospitals (one academic, two community) and clinics (N = 86) on December 19, 2017. We evaluated the impact on FQ duration by comparing mean duration and percent of 10 day durations in the 12 months pre-default duration removal (DDR) and 3 months post-DDR. All inpatient or outpatient encounters with an FQ e-script with days duration less than 31 days were included. FQ durations were captured in days duration fields or calculated from sig and quantity fields. We used descriptive statistics to compare FQ duration pre- and post-DDR using a chi-squared test.ResultsA total of 35,765 FQ e-scripts and 276,056 FQ e-script days of therapy were included pre-DDR. The post-DDR included 9,526 FQ e-scripts and 71,028 FQ e-script days of therapy. Mean (standard deviation) durations in the pre- and post-periods were 7.78 (4.35) and 7.55 (3.99), respectively (P < 0.001). Common discharge durations in both time periods across all settings were 5, 7, and 10 days. The 10-day default duration was the most common in the pre-DDR with 11,000 e-scripts (31%), and declined by 16% (2,475 e-scripts, 26%) in the post-DDR period. The academic center realized the greatest shift away from 10-day default duration (Table 1).ConclusionRemoval of default e-script durations, a novel and minimally resource intensive strategy, reduced prescribed duration of FQ therapy.Table 1: Ten-day Durations for Fluoroquinolone E-scripts Pre- and Post-DDRPractice SettingPre-DDRN (%) 10 day E-scriptsPost-DDRN (%) 10 day E-scripts% Change Pre–PostAcademic Medical Center771 (20)125 (11)-42Community hospital452 (20)90 (15)-23Community hospital514 (24)126 (21)-16Outpatient9,263 (34)2,134 (30)-12Total11,000 (31)2,475 (26)-16Disclosures All authors: No reported disclosures.