Validation and Evaluation of Antimicrobial Orders Indication for Use

Abstract

BackgroundDocumenting indication for antimicrobial use is a best practice and stewardship initiative recommended by the CDC. On September 20, 2016, a mandatory selection of antimicrobial indication as empiric, pathogen-directed, or prophylaxis was implemented for all prescribers within Cleveland Clinic Health System (CCHS), which comprises of an academic medical center and 8 community hospitals in Ohio, and 1 community hospital in Florida. This study sought to validate and describe prescriber-entered indications to ensure accurate measurement of prescribing patterns and guide future stewardship initiatives.MethodsRetrospective study evaluating a 24-hour period on 10/19/2016 to manually validate indications of non-order set antimicrobials and describing antimicrobial indications from October 1–31, 2016. Validation of indications was done via chart review evaluating microbiology results. The primary endpoint was proportion of antimicrobial orders at CCHS with a validated indication for use. Secondary endpoints: prevalence of indications for antimicrobial use on a health-system and hospital-level and types of antimicrobials prescribed.ResultsOn October 19, 2016, 899 antimicrobial orders were validated (Figure 1). Validated indications by prescriber type: 82% physicians, 80% pharmacists, and 78% advanced practice providers. During October 2016, there were 39,312 antimicrobials orders: 53% empiric, 31% prophylaxis, and 16% pathogen-directed. The trend in prevalence of indications being highest for empiric followed by prophylaxis then pathogen-directed was also observed on a hospital-specific level. While vancomycin and piperacillin/tazobactam accounted for a significant percentage of empiric antimicrobial use across CCHS, at certain regional hospitals, there was a relatively higher rate of empiric use of fluoroquinolones.ConclusionAcross CCHS, majority of the prescriber-entered indications were validated to be accurate. Empiric antimicrobial indication was the most prevalent, followed by prophylaxis and pathogen-directed. Future stewardship intervention targeting antimicrobial use after 72 hours of empiric therapy will be pursued.Disclosures All authors: No reported disclosures.