Acceptance Rate Of Interventions Research Articles

Significance of a clinical pharmacist-led comprehensive medication management program for hospitalized oncology patients.

Background The use of highly toxic drugs in cancer treatment and supportive care medications exposes patients to an increased number of drug-related problems (DRPs). Clinical pharmacists contribute to the optimal use of medications by intervening in identified drug-related problems. Objective To evaluate the relevance of a comprehensive medication management service in oncology patients. Setting Marmara University Teaching and Research Hospital Medical Oncology Ward, Istanbul, Turkey. Methods This prospective study was carried out between December 2015 and April 2016 with adult patients with confirmed malignancy. Comprehensive medication management was performed by the clinical pharmacist throughout the patient's hospital stay. The medication-related data as well as data regarding demographic and general health status of the patients were reviewed for the presence of drug-related problems. The identified problems, interventions and acceptance rate by physicians were recorded with the help of the Pharmaceutical Care Network Europe V6.0 (PCNE) classification. Main outcome measures Number and causes of drug-related problems, nature and acceptance rate of clinical pharmacist interventions and rate of problems solved. Results The study included 137 patients. The mean (SD) age of the patients was 58 (14.6) years. A total of 481 drug-related problems were recorded. The most frequent drug-related problems were 'adverse drug events [including drug interactions]' (n = 376), 'untreated indications' (n = 59) and 'unnecessary drug treatment' (n = 25). Inappropriate combination of drugs was the cause of 73.2% of the total problems. Interventions were made to stop administration of a suitable drug if the combination with another drug was contraindicated while prescribers were mostly informed about major drug interactions. The prescribers approved 93% of the total intervention proposals. The majority (90.9%) of the identified problems were totally solved. Conclusion Integration of clinical pharmacy services through a comprehensive medication management program in oncology will help to reduce the number of drug-related problems.

Physicians\u2019 acceptance of pharmacists\u2019 interventions in daily hospital practice

Background The physicians’ acceptance rate of pharmacists’ interventions to improve pharmacotherapy can vary depending on the setting. The acceptance rate of interventions proposed by pharmacists located in the hospital pharmacy over the telephone and factors associated with acceptance are largely unknown. Objective To determine the physicians’ acceptance rate of pharmacists’ interventions proposed over the telephone in daily hospital practice and to identify factors associated with acceptance. Setting A retrospective case–control study was performed concerning adult patients admitted to a university hospital in the Netherlands. Method Pharmacists’ interventions, based on alerts for drug–drug interactions and drug dosing in patients with renal impairment, recorded between January 2012 and June 2013 that were communicated over the telephone were included. Factors associated with physicians’ acceptance were identified with the use of a mixed-effects logistic model. Main outcome measure The primary outcome was the proportion of accepted interventions. Results A total of 841 interventions were included. Physicians accepted 599 interventions, resulting in an acceptance rate of 71.2%. The mixed-effects logistic model showed that acceptance was significantly associated with the number of prescribed drugs (16 to ≤ 20 drugs ORadj 1.88; 95% CI 1.05–3.35, > 20 drugs ORadj 2.90; 95% CI 1.41–5.96, compared to ≤ 10 drugs) and the severity of the drug-related problem (problem without potential harm ORadj 6.36; 95% CI 1.89–21.38; problem with potential harm OR 6.78; 95% CI 2.09–21.99, compared to clinically irrelevant problems), and inversely associated with continuation of pre-admission treatment (ORadj 0.55; 95% CI 0.35–0.87). Conclusion Over the study period, the majority of pharmacists’ interventions proposed over the telephone were accepted by physicians. The probability for acceptance increased for patients with an increasing number of medication orders, for clinically relevant problems and for problems related to treatment initiated during admission.

1055. Addition of Antimicrobial Stewardship Program Weekend Coverage Increases Interventions while Reducing Antimicrobial Duration and Cost

BackgroundExpansion of Antimicrobial Stewardship Program (ASP) activities to include coverage of weekends has been shown to facilitate further optimization of antimicrobial usage. Beginning July 2018, we implemented full ASP coverage on weekends from 0700–1530 by infectious diseases (ID) clinical pharmacists and pharmacy residents. We sought to evaluate the impact of the addition of weekend ASP coverage on the number of interventions, antimicrobial duration and cost of target broad-spectrum antimicrobials.MethodsAntimicrobials reviewed by ASP on a weekend day between July 14, 2018 and December 16, 2018 were included in the analysis. The primary outcome was the number and type of documented interventions associated with the antimicrobials reviewed. Secondary outcomes included the total duration of meropenem, daptomycin, and micafungin initiated on a weekend, estimated expenditures on these target broad-spectrum antimicrobials, and comparison of the average number of interventions performed per day by ID clinical pharmacists vs. pharmacy residents. For comparison, we also evaluated these secondary outcomes prior to ASP weekend coverage, between July 16, 2017 and December 9, 2017.ResultsA total of 688 antimicrobials were reviewed on weekend days during the included time-frame with 753 interventions (average number of interventions/day: 37). Table 1 summarizes the type of interventions. The acceptance rate for interventions was 99%. The average number of interventions per day for ID clinical pharmacists vs. pharmacy residents was 57.9 and 26.2, respectively. Table 2 shows the total duration of therapy (DOT) and total expenditures on target antimicrobials before and after ASP weekend coverage. The total DOT of target antimicrobials agents decreased from 21 days to 7 days, with an estimated 3,165 dollar decrease in expenditures during the included time-frame.ConclusionExpansion of ASP coverage to include weekends allowed us to provide 753 interventions over 4 months that would not otherwise have been made when no ASP coverage was available. This was associated with a reduction in broad-spectrum antimicrobial duration of therapy and expenditures when compared with weekends where ASP weekend coverage was not available. Disclosures All authors: No reported disclosures.

2068. Outpatient Antimicrobial Stewardship: Optimizing Patient Care Via Pharmacist Led Culture Review

BackgroundAntimicrobial stewardship programs are well established in the inpatient setting; however, progress has lagged in the outpatient setting. With a growing need for outpatient stewardship, data are needed to guide the development of new services to improve patient care. Many times, cultures are taken in the outpatient setting but results are not acted upon, leading to unnecessary re-presentations to the healthcare setting.MethodsThis study was a prospective chart review via the computerized patient record system with interventions made as needed between January 1, 2018 and January 1, 2019. Infectious Diseases received alerts when oral antibiotics for outpatient use were ordered. Cultures were reviewed daily to ensure drug-bug match and timely interventions. The primary objective of this study was to compare outcomes in patients with accepted interventions vs. rejected interventions: 30-day re-presentation rates, 30-day admission rates, and 30-day treatment failure. Descriptive statistics were used to summarize data.ResultsA total of 7,360 antibiotic orders were reviewed in real time by Infectious Diseases. Of which, 965 encounters with cultures were included in the culture review service. Pharmacists intervened on 20.1% (n = 194) of patient encounters. The majority of antibiotic prescriptions that required intervention were from the emergency department (42%) and primary care (39%), with the remaining 19% being from various outpatient specialty clinics. The most common antibiotics prescribed for patients requiring intervention were ciprofloxacin (26%), third-generation cephalosporins (22%), and sulfamethoxazole/trimethoprim (18%). The most common indication for use was urinary tract infection. The intervention acceptance rate was 76%. Intervention significantly decreased rates of 30-day treatment failure (5% vs. 28%, P < 0.0001) and 30-day admission (0.7% vs. 11%, P = 0.0005) when interventions were accepted rather than rejected.ConclusionCulture review service positively impacted outcomes for patients in the outpatient setting. For those antibiotic orders that required intervention, the intervention significantly decreased rates of 30-day treatment failure and 30-day admission when interventions were accepted.Disclosures All authors: No reported disclosures.

2083. A Targeted Remote Audit and Feedback Intervention Utilizing a Local Non-ID Trained Pharmacist

BackgroundTele Stewardship (tASP) is a developing model for hospitals without local ID expertise. We report results of a tASP initiative using a hospital’s local non-ID trained pharmacist to conduct ertapenem (erta) audit and feedback (A&F).MethodsEvaluation of erta use before and after implementation of a collaborative A&F process from October 2018 to March 2019. A central ID physician and ID pharmacist with EMR access reviewed charts of patients receiving erta Mon-Fri by phone with a local Critical Care trained pharmacist. Advice was given to the local pharmacist on when and how to intervene. The local pharmacist made all interventions. Acceptance rates and time involved were recorded. Usage was tracked as DOT/1,000 PD of inpatient usage. No other new local ASP interventions were undertaken during this time.Results120 erta orders were reviewed. Figure 1 reveals usage before and after implementation. Median usage dropped 55%. Median purchasing cost decreased by 73%. 51 unique patients received erta in the month prior to intervention, and 35 patients per month on average received erta afterwards. 30 providers ordered erta in the month prior to intervention, and 17 providers per month on average ordered erta afterwards. The overall intervention acceptance rate was 88%, and Figure 2 shows the breakdown of accepted interventions. Figure 3 describes the indications for use of erta orders after intervention started. Figure 4 shows changes in other antibiotics during this time. During this time, no patients were identified that later needed a carbapenem restarted or suffered harm due to this intervention. The average daily time required was 15 minutes for the central team and 22 minutes for the local pharmacist.ConclusionUsing a remote collaboration with a local pharmacist, we showed a marked decrease in the use of one targeted antimicrobial. The time commitment was minimal, and no patient harm was identified. Tele-stewardship utilizing local non-ID trained pharmacists can be a significant tool for improving antimicrobial use in community hospitals. tASP’s should monitor for compensatory increase in other broad-spectrum antibiotics. Further local education regarding proper management of UTI’s and other common conditions may provide additional improvements in use of erta. Disclosures All authors: No reported disclosures.

192. Augmenting Utility of Rapid Diagnostic Testing in Treatment of Gram-Negative Bacteremia with Stewardship Intervention

BackgroundRapid diagnostic tests (RDT) can identify pathogens in bloodstream infections (BSI) in less than 24 hours. Our institution utilizes an RDT for blood cultures (BCx) that can detect various organisms and resistance determinants. A retrospective evaluation conducted in our institution calculated the negative predictive values (NPV) of various Gram-negative pathogens and susceptibility to target antimicrobials in the absence of detected resistance markers. Resultant NPV >90% for E. coli and K. pneumoniae to ceftriaxone support use of RDT with stewardship intervention for more rapid de-escalation of antimicrobial therapy in patients with resistance marker-negative BSI.MethodsIn our facility, all positive BCx are processed through RDT. In the post-intervention group, pharmacists monitored RDT results and provided recommendations. Our IRB-approved, prospective study assessed time to antimicrobial de-escalation in treatment of resistance marker-negative E. coli and K. pneumoniae BSI before (January 1 to December 31, 2018) and after Stewardship intervention (January 1 to March 31, 2019). Secondary outcomes included days of therapy (DOT) of target narrow-spectrum β-lactams, carbapenems, and non-carbapenem anti-pseudomonal (NCAP) β-lactams, length of stay (LOS), and treatment failure. Data were analyzed using the Fisher exact or Chi-square and t-test for categorical and continuous data, respectively.ResultsOf the 12,893 evaluated RDT results in the pre-intervention group and 2,238 post intervention, 41 and 12 patients met inclusion criteria, respectively. Baseline characteristics were similar in both groups. Time to de-escalation to a target agent was decreased by 24 hours after stewardship intervention (50 v 74.6 hours) (P = 0.14). There were no statistically significant differences in DOTs for target agents (5.19 v 5.25 DOT; P = 0.48), carbapenems (1.29 v 1.08 DOT; P = 0.41), or NCAP β-lactams (1.73 v 2.33; P = 0.25). Treatment failure (2 in each group; P = 0.17) and LOS (10.9 v 11.9 days; P = 0.4) were similar between groups. Protocol compliance and intervention acceptance rate was approximately 60%.ConclusionAppreciation of NPVs and utilization of stewardship intervention allowed for early de-escalation of empiric therapy in patients with resistance marker-negative E. coli and K. pneumoniae bacteremia. Disclosures All authors: No reported disclosures.

1069. Implementation and Results of a Health-System Antimicrobial Stewardship (AMS) Program

BackgroundAMS expansion initiative was implemented in fiscal year 18 (FY18) across a 14-member health system (~1,000 average daily census combined) consisting of 8 community hospitals, 5 rural critical access hospitals and 1 academic medical center.MethodsThe expansion initiative included a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician and 2.5 FTE ID-trained clinical pharmacists to support daily AMS activities. Clinical decision support software (Theradoc) had previously been implemented across the health system. Here we report our continuation results for the first 9 months of year 2 (FYTD19) of the expansion initiative.ResultsAMS personnel documented an average of 319.8 and 313.2 interventions per month in FY18 vs. FYTD19, respectively. Mean acceptance rate of AMS interventions by providers was 87.9% and 89.4% in FY18 vs. FYTD19. Provider groups with the highest acceptance rate were Hospital Medicine, Pulmonary/Critical Care and Infectious Disease. Highest interventions in FYTD19 included recommending other diagnostic testing (17%) followed by de-escalating/targeting therapy based on culture results and recommending alternative therapy (both at 11%). Most common ID disease states AMS intervened included bacteremias (29%), pneumonias (ventilator-associated or community-acquired) 13% each, and UTIs 13%. AMS interventions generated 168 ID consults in FYTD19. The financial impact of AMS across the health system was a cumulative saving in antimicrobial expenditures of $1.29 million and $1.27 million in FY18 and FYTD19, respectively.ConclusionThe ability to review offsite electronic medical records daily for antimicrobial optimization with ID pharmacist and physician support, identify facility-specific needs and opportunities, and collect available data endpoints to determine program effectiveness has helped to ensure program success.Disclosures All authors: No reported disclosures.

756. Impact of Infectious Diseases Pharmacists as Part of an Interdisciplinary OPAT Team Managing Vancomycin

BackgroundOutpatient Parenteral Antimicrobial Therapy (OPAT) is a growing area of Infectious Diseases (ID) that allows for the treatment of severe infections in the ambulatory setting. Massachusetts General Hospital (MGH) incorporated inpatient ID pharmacists into the OPAT team in June 2017 to assist with vancomycin monitoring and dosing. Laboratory results were received and documented by the OPAT nurse and forwarded to the pharmacists for assessment via the electronic medical record (EMR). Pharmacists then sent clinical recommendations to the physician. This study aimed to determine the impact of pharmacists’ involvement in OPAT vancomycin management.MethodsAn EMR-generated report identified patients in the OPAT program from June 2016 through May 2017 as the control group and June 2017 through May 2018 as the intervention group. One hundred patients were randomly selected during each period. Patients were excluded from the intervention group if no pharmacist documentation was present. The primary outcome was to evaluate the proportion of vancomycin levels within the patient-specific goal range and secondary outcomes included the proportion of (1) pharmacists’ recommendations accepted by the ID physician and (2) patients who experienced adverse drug events.ResultsA total of 200 patients were evaluated. The most common indication for enrollment was osteomyelitis (46%). No differences in baseline characteristics were noted, and the median age was 67 years. The percentage of vancomycin levels within goal was significantly higher in the pharmacist-managed group compared with the control group (66.8% vs. 54.2%; P < 0.0001). The number of patients who experienced adverse drug events was similar between the two groups (39% vs. 43%; P = 0.66); however, fewer patients in the pharmacist group experienced acute kidney injury (5% vs. 13%; P = 0.08). Finally, 100% of pharmacist recommendations were accepted by ID physicians.ConclusionLeveraging inpatient ID pharmacists at MGH in the management of OPAT vancomycin provided improved percentage of vancomycin in therapeutic range and high acceptance rate of interventions. Further evaluation is necessary to assess the inpatient ID pharmacists’ workflow for implementation into other OPAT programs. Disclosures All authors: No reported disclosures.

1141. Implementation of a Pediatric Handshake Antimicrobial Stewardship Program to Improve Antimicrobial Utilization

BackgroundAntimicrobial stewardship (AMS) programs emerged in response to rising rates of resistance and adverse effects associated with inappropriate antimicrobial utilization. Optimal metrics and strategies (e.g., preauthorization, prospective audit and feedback) for AMS remain to be elucidated. This study evaluated the impact of a multidisciplinary, rounding-based AMS strategy (i.e., Handshake Stewardship) on antimicrobial utilization and prescribing practices at a pediatric hospital.MethodsThis was a single-center, retrospective quality improvement study at a community, teaching children’s hospital. All pediatric and neonatal inpatients with active antimicrobial orders between July 2018 and March 2019 were included in the study, and endpoints were compared with data from July 2017- March 2018. Antimicrobial courses were prospectively audited by a multidisciplinary AMS team, and feedback was provided to the primary teams during Handshake Stewardship rounds. The primary endpoint was a number of interventions made and the corresponding acceptance rates. The secondary endpoint was days of therapy (DOT) per 1000 patient-days. Descriptive statistics were performed on all continuous and categorical data as appropriate.ResultsOf 2238 antimicrobial courses reviewed, 710 (32%) required intervention, and 86% of the interventions made were accepted. The top 3 indications evaluated were respiratory (n = 522, 23%), sepsis/bacteremia (n = 351, 16%), and surgical prophylaxis (n = 266, 12%). Of the respiratory courses reviewed, there were 228 opportunities for antimicrobial optimization. The most common interventions were: bug-drug optimization (n = 208, 29%), discontinuation of anti-infective (n = 136, 19%), and dose optimization (n = 120, 17%). No significant difference was observed for overall, ceftriaxone, meropenem, and vancomycin DOT pre- and post-implementation of Handshake Stewardship. However, a statistically significant reduction in DOTs was observed for piperacillin–tazobactam (15.2 vs. 7.4, P = 0.004) and a nonsignificant reduction in meropenem (9.5 vs. 6.2).ConclusionRounding-based, Handshake AMS was associated with overall high intervention acceptance rates and a reduction in commonly utilized broad-spectrum antimicrobials.Disclosures All authors: No reported disclosures.

Outpatient antimicrobial stewardship: Optimizing patient care via pharmacist led microbiology review

Cultures are often taken in the outpatient setting but results are not acted upon, leading to unnecessary re-presentations to the health care setting. This study was a prospective study with interventions made between January 1, 2018, and January 1, 2019. Cultures were reviewed to ensure appropriate antimicrobial coverage. The objective was to compare outcomes with accepted versus rejected interventions. Descriptive statistics were used to summarize data. A total of 7,360 antibiotic orders were reviewed by the infectious diseases pharmacists. Pharmacists intervened on 20.1% (n = 194) of encounters with related cultures. Interventions were most frequent in the emergency department (42%). Ciprofloxacin required the most interventions (26%), followed by third-generation cephalosporins (22%). The intervention acceptance rate was 76%, which was associated with decreased rates of 30-day treatment failure (5% vs 28%, P < .001) and 30-day admission (0.7% vs 11%, P = .001), when interventions were accepted rather than rejected. Approximately 20% of patients required intervention. Culture review services may be beneficial in a variety of outpatient settings. Outpatient stewardship literature is limited, and our study found a decrease in admission and treatment failure. Microbiology review and intervention positively impacted care for outpatients. Intervention was associated with significantly decreased rates of treatment failure and admission when interventions were accepted.

Nutrition support for critically ill patients in China: role of the pharmacist.

The participation of a nutrition support pharmacist (NSP) in a multidisciplinary team (MDT) for patients receiving nutrition support therapy (NST) may lead to more favourable outcomes and fewer complications and adverse events. However, few studies have demonstrated the role of NSPs in MDTs in China. To investigate pharmacy interventions and physician acceptance of these interventions for patients receiving NST in an intensive care unit (ICU). A prospective study over a 12-month period was conducted in an ICU at an academic hospital in China. Interventions were documented and divided into the following categories: indication of NST, parenteral nutrition (PN) prescription and delivery, enteral nutrition (EN) route and formulation, fluids and electrolytes, laboratory test monitoring, nutritional supplements, and other medication-related problems. Data regarding the intervention categories, timing, acceptance rates, and methods of communication to discuss pharmacy interventions were collected. In total, 247 interventions for 120 patients were identified. The overall acceptance rate of interventions was 85.0% (210/247), and more than half of the interventions (143, 57.9%) were performed during daily follow-up. The most common intervention categories were PN prescription and delivery (81/247, 32.8%), EN route and formula (33/247, 13.4%), indication of NST (33/247, 13.4%), and nutritional supplements (30/247, 12.1%). The most accepted intervention category was PN prescription and delivery (79/81, 97.5%), and the most common method of communication was oral communication during MDT rounds (201/247, 81.4%). This study demonstrated the unique perspectives offered and importance of having pharmacists as members of MDTs.

Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study.

PurposeAging increases the prevalence of diseases. The elderly population is consequently often exposed to complex medication regimens. Increased drug use is one of the main reasons for drug-related problems (DRPs). The primary objective of this study was to define and classify DRPs, pharmacist interventions, and frequently prescribed medications in relation to possible DRPs in patients admitted to the geriatric ward of a teaching hospital in Turkey.Patients and methodsPharmacist medication review reports for 200 orders of 91 patients (mean age: 80.33±0.46) were analyzed retrospectively.ResultsA total of 1,632 medications were assessed and 329 interventions were proposed for possible DRPs in 156 orders. A total of 87.5% of the patients used five or more drugs (mean: 8.17±0.23). The number of DRPs per order was higher when polypharmacy was present (1.04±0.15 vs 1.66±0.11, P<0.05). In 71.31% of the cases, adverse drug events were recognized as the problem. The principal cause of possible DRPs was determined as drug interactions (40.12%). Only 22 potentially inappropriate medications were prescribed. The most common interventions included monitoring drug therapy (31.0%), stopping the drug (20.06%), and changing dosage (13.98%). The acceptance rate of pharmacist interventions by treating geriatrician was 85.41%. The most frequently prescribed drugs were for the nervous system, alimentary tract and metabolism, and cardiovascular system (n=358, 314, and 304, respectively). The pharmaceutical forms of 23 drugs were deemed inappropriate by pharmacists.ConclusionClinical pharmacy services are still not properly implemented in Turkey. The study highlights ways in which clinical pharmacy services can be instrumental in a geriatric ward. The high acceptance rates of pharmacist recommendations concerning a wide variety of DRPs and different classes of drugs indicate that advanced collaboration among geriatricians and pharmacists is possible in interdisciplinary geriatric assessment teams in Turkey.

Factors Influencing Acceptance Into Part C Early Intervention Among Low-Risk Graduates of Neonatal Intensive Care Units

Low-risk infants discharged from a neonatal intensive care unit (NICU) can include infants whose stay was due to late-term prematurity, suspicion of sepsis, breathing issues, and/or feeding challenges. This study aimed to identify the degree to which sociodemographic and medical factors contribute to low-risk NICU graduates being accepted into Part C early intervention services. Family sociodemographic and child medical factors were examined for 3,826 low-risk graduates of NICUs in 1 Midwestern state. These NICU graduates were compared with the general population of children birth to age 3 years in the state for rates of enrollment in Part C programs. Low-risk NICU graduates had significantly higher early intervention acceptance rates than children in the general population. Neonatal intensive care unit graduates residing in an urban area were more likely to be accepted into early intervention services than those residing in a rural area. The length of NICU stay also predicted acceptance into services; the likelihood of acceptance into early intervention programs increased for each additional day a child stayed in the NICU. Low-risk NICU graduates should be monitored routinely after discharge for developmental delays and the need for referral to Part C early intervention programs any time in the children's first 3 years of life.

228. Impact of Early Alert to Antimicrobial Stewardship Interventions with the Prospective Audit and Feedback Strategy

BackgroundProspective audit-feedback is the primary strategy adopted by our hospital antibiotic stewardship program (ASP). It is labor-intensive and successful uptake relies on the visibility of the written intervention note. A rapid notification system (RNS), whereby the physical note is replaced by an electronic document followed by immediate prescriber alert through text messaging, was recently implemented. We seek to quantify the impact of this initiative on patient outcomes and ASP resource utilization.MethodsInterventions to discontinue, de-escalate, or switch from intravenous to oral antibiotics in the pre-implementation (P1: January 2016–February 2017) and post-implementation (P2: March 2017–February 2018) periods were identified from the ASP database. Same-day intervention acceptance rate (IAR), duration of antibiotic therapy (DOT), and hospital length of stay (LOS), measured from day of intervention to discharge, were compared. Manpower time saved from having to perform a next-day intervention follow-up (15 minutes/intervention) was calculated.ResultsA total of 1,904 (11.4%) and 1,311 (12.4%) interventions of 16,723 and 10,545 antibiotic audits were made during P1 and P2, respectively. There were no significant differences in antibiotic or intervention types between both periods–piperacillin–tazobactam (85.4%) was most common, followed by meropenem (11.4%); intervention to discontinue antibiotic (68.4%) was most frequent. Implementation of RNS led to a pronounced 2.5-fold increase in same-day IAR (19.3% vs. 47%, P < 0.01). Potential savings in ASP manpower was estimated at 75 hours/year. Overall improvement in IAR at 48-hours was also observed (79.2% vs. 82.5%, P = 0.02). Patients with ASP interventions accepted on the same day had significantly shorter DOT (4.4 vs. 5.4 days, P < 0.01) but not LOS (13.4 vs. 11.6 days, P = 0.08). Thirty-day-day infection-related mortality rates were similar across the two periods (3.3% vs. 3.3%).ConclusionAn early alert to ASP interventions can strengthen the impact of ASP in reducing unnecessary antibiotic use without compromise in patient safety. ASPs, particularly those serving large and busy hospitals, should consider having an RNS in place to improve program efficiency and visibility.Disclosures All authors: No reported disclosures.

1797. Combining Rapid Diagnostics With Pharmacy Resident-Led Antimicrobial Stewardship to Optimize Outcomes for Bacteremia With Methicillin-Resistant S. aureus (MRSA-B), Methicillin-Susceptible S. aureus (MSSA-B), and Coagulase-Negative Staphylococcus (CoNS) at Yale New Haven Hospital (YNHH)

BackgroundGiven the severity of S. aureus bacteremia, prompt initiation of appropriate antibiotics is key. YNHH implemented the Cepheid® Xpert MRSA/SA PCR in an effort to decrease the time needed to identify MRSA-B, MSSA-B, and CoNS. The impact of rapid diagnostics has been limited without stewardship or infectious disease involvement. Our unique notification algorithm utilized our on-call pharmacy residents to allow for 24/7 coverage. The primary objective was time to optimal antibiotic therapy (OAT) before and after implementation of the PCR and algorithm. Secondary outcomes included time to blood culture clearance (BCC), acceptance rate of pharmacist interventions, days of vancomycin therapy avoided, and 30-day mortality.MethodsA retrospective cohort study was conducted in adult inpatients with blood cultures positive for Gram positive cocci in clusters. The pre-implementation, control group (CG) included patients from April 2017 to October 2017 and the post-implementation, intervention group (IG) was from October 2017 to April 2018. Patients <18 years and polymicrobial bacteremia were excluded. Data collected in addition to primary and secondary outcomes included baseline demographics, allergies and empiric antibiotics. OAT included vancomycin for MRSA-B or MSSA-B with severe β-lactam allergy; nafcillin or cefazolin for MSSA-B; and discontinuation of vancomycin for CoNS deemed a contaminant.ResultsOf the 544 patients reviewed, 434 met inclusion criteria: 182 in the CG and 252 in the IG with similar baseline characteristics. Mean time to OAT decreased from 10 hours in the CG to 5 hours in the IG (P = 0.006). Time to BCC in the CG and IG cohorts decreased from 100 to 43 hours (P = 0.0001). One day of vancomycin was avoided in patients with MSSA-B and 2 days with CoNS. 30-day mortality decreased from 18% (n = 32) in the CG vs. 6% (n = 15) in the IG (P = 0.0001). Finally, 95% (n = 153/161) of pharmacist interventions were accepted.ConclusionUtilizing the on-call pharmacy resident for notification of rapid diagnostic results for S. aureus bacteremia, we saw a significant decrease in time to OAT, BCC, and 30-day mortality. Our study demonstrates that in the setting of limited stewardship resources, additional members of the healthcare team can be used to optimize antibiotics in conjunction with rapid diagnostics.Disclosures All authors: No reported disclosures.

1805. Impact of Antimicrobial Stewardship Interventions Using Rapid Molecular Testing on the Appropriate Use of Antiviral Therapy and Reduction of Unnecessary Antibiotic Therapy for Patients Admitted With Acute Influenza

BackgroundRapid molecular tests combined with Antimicrobial Stewardship Program (ASP) interventions have provided opportunities to optimize patient outcomes and reduce unnecessary antimicrobial use. Our institution currently uses an FDA approved influenza/respiratory syncytial virus polymerase chain reaction (PCR) assay and multiplex respiratory panel. In addition, our institution commonly utilizes procalcitonin (PCT) levels. The ASP at Summa Health System – Akron Campus (SHS-AC) routinely recommends use of these rapid diagnostic tests to assist with antimicrobial and antiviral usage, including the discontinuation of antibiotics in influenza positive patients in the absence of a concurrent bacterial infection.MethodsA retrospective review of all ASP interventions on influenza positive patients at SHS-AC was performed from December 2017 to March 2018. The ASP reviewed all patients on broad-spectrum antibiotics >48 hours and all influenza positive patients without Infectious Disease consultation. The appropriateness of antimicrobial and antiviral therapy was assessed, including assessment of culture and PCR results, PCT levels, indication of therapy, and renal function. For patients with a positive influenza PCR and low PCT without evidence of bacterial infection, the recommendation was to discontinue antibacterial use. Data collected included: intervention type, acceptance rate, PCT levels, and influenza subtype.ResultsTwo hundred thirty-three total recommendations were made by the ASP on influenza positive patients, with a 96.6% acceptance rate. Interventions included the following: obtain PCT level (54/233), de-escalate or stop antibiotics based on culture, PCR, and PCT results (116/233), obtain influenza or respiratory PCR (8/233), initiate oseltamivir (37/233), and other (18/233).ConclusionASP intervention combined with PCT levels and PCR results contributed to the reduction of unnecessary antibiotic use, and the initiation of oseltamivir therapy in influenza-positive patients.Disclosures T. File, BioMerieux: Scientific Advisor, Consulting fee. Curetis: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. Merck: Scientific Advisor, Consulting fee. MotifBio: Scientific Advisor, Consulting fee. Nabriva: Investigator and Scientific Advisor, Consulting fee and Research grant. Pfizer: Scientific Advisor, Consulting fee. Paratek: Scientific Advisor, Consulting fee.

PCN5 - Evaluation of Pharmacists' Impact on Hematology Oncology Chemotherapy Orders

This study aims to evaluate the impact of the pharmacist interventions on hematology/oncology chemotherapy orders at a hematology pharmacist clinic using the Hatoum scale. It also aims to ascertain the patient experience after attending the hematology pharmacist clinic. The study was carried out at the Princess Margaret Hospital, a local tertiary public hospital in Hong Kong. Pharmacist interventions from hematology pharmacist clinic were collected over a 17-months period. Interventions were analyzed for intervention type, cause of drug-related problems, and acceptance rate. Each intervention was evaluated for its clinical significance by an independent hematologist and a board certified oncology pharmacist using the Hatoum scale. A patient experience survey on the hematology pharmacist clinic was conducted from September 2016 to February 2017 and subsequently analyzed. A total of 241 interventions were recorded. The most commonly identified drug-related problems were "no drug prescribed but clear indication" (23%), "necessary information missing on prescription" (21%), "inappropriate dilution concentration of chemotherapy drugs" (11%), and "inappropriate dosage" (10%). Acceptance rate of interventions was 99%. Respectively, 88% and 100% of the interventions were rated as significant using Hatoum scale by the hematologist and the board-certified oncology pharmacist. Twenty-eight completed patient experience surveys were obtained. Ninety-six percent of the patients were satisfied with the hematology pharmacist clinic and reported improved knowledge on chemotherapy, improved competency in handling side effect and better understanding on goals of therapy. The pharmacist interventions made in the hematology pharmacist clinic enhanced medication safety and delivery by performing clinical screening and making appropriate recommendations to care providers. This service model should be sustained to continuously benefit patient care.

Descriptive Analysis of Acceptance by Prescribers and Economic Benefit of Pharmacist Recommended Interventions in a Critical Care Unit.

Pharmacist clinical intervention is defined as the action that identifies and prevents medication-related problems and optimizes patient's medication therapy in cooperation with other healthcare professionals. Types of clinical interventions may vary, but each is patient specific. Few studies have focused on clinical pharmacists interventions in a critical care setting at a rural hospital. The purpose of this study was to assess physician acceptance rate of pharmacist-recommended interventions in the critical care unit (CCU) at a rural hospital over five years and to evaluate the economic benefit of accepted pharmacist-recommended interventions over a one-year time period. This study was a retrospective chart review over a five-year time period. Each intervention was categorized and analyzed for acceptance or non-acceptance by the treating physician. Evaluation of economic benefit, cost saving and cost avoidance, for a one-year time period was performed. A total of 1275 interventions were documented during study period. The average acceptance rate for documented interventions was 56%. The acceptance rate by physicians increased over the study period; with the acceptance rate in 2013 being statistically significantly higher than any other years. The overall cost saving for selected interventions was $432 for the one year. The overall cost avoidance of all accepted interventions for the one year was $453,339.36-$468,327.62. Clinical pharmacists provide various types of interventions to improve patient care. The analysis of potential cost saving and cost avoidance of selected interventions illustrated a positive economic outcome.

Pharmacist Outpatient Prescription Review in the Emergency Department: A Pediatric Tertiary Hospital Experience.

This study aimed to assess the frequency, type, and potential severity of errors intercepted by pharmacists on review of discharge prescriptions in a pediatric emergency department (ED). This was a retrospective, observational study conducted in the ED of a pediatric teaching hospital. A daily report of prescriptions from the previous day was reviewed by a pharmacist for safety and efficacy. If an intervention was deemed necessary, the prescriber was contacted for clarification. In situations where patient harm could occur, the physician performing follow-ups was contacted by phone. The interventions were categorized based on type and potential severity. Physician response rates and intervention acceptance rates were assessed. Approximately 23,600 prescriptions were reviewed during a 1-year period with 60 interventions (0.25% intervention rate). Of the 60 interventions, 3% were estimated to have no severity, 80% were estimated to have minor, 12% moderate, and 5% major potential severity. The most common types of interventions were optimization of therapy, drug overdose, or dose omission at 33%, 32%, and 14%, respectively. Eighty-five percent of physicians responded; 73% accepted the intervention whereas 27% provided a rationale for their decision. More importantly, valuable information was gained, allowing for implementation of system fixes to prevent future errors. On an average, pharmacists spent 45 minutes reviewing and clarifying prescriptions each day. Pharmacists in the ED can provide a valuable service by reviewing discharge prescriptions. A small amount of time dedicated to this service can lead to detection of clinically significant preventable medication errors and optimization of prescription therapy.

An evaluation of the intravenous to oral antimicrobial conversion program in the inpatient setting

AbstractThe Antimicrobial Stewardship Program (ASP) team at the National University Hospital (NUH) Singapore has compiled intravenous to oral (IV‐to‐PO) antibiotics conversion guidelines and conducted training sessions with pharmacists on IV‐to‐PO conversion. The primary aim of this study was to assess compliance with IV‐to‐PO guidelines, pre‐ and post‐implementation of training, and to evaluate the acceptance rate and timeliness of pharmacist interventions for IV‐to‐PO antibiotic conversion. A chart‐review study for two cohorts of patients newly prescribed IV clindamycin or metronidazole was conducted over two 6‐week periods following training sessions detailing hospital recommendations for converting suitable patients to oral therapy. Cases were reviewed to compare IV‐to‐PO interventions by the end of 7 days and review the effectiveness of training and timeliness of any pharmacist intervention. There was no difference in proportion of patients suitable, but not converted to oral therapy by the end of 1 week (41/125 vs 30/115, p = 0.255) following the training session. There was also no significant difference in documented IV‐to‐PO antibiotic intervention rates (3/41 vs 5/30, p = 0.18) by pharmacists. Few pharmacists are actively intervening to convert patients from IV‐to‐PO antibiotics. Training was ineffective in improving intervention rates. These results show that the ASP team needs to come up with better strategies to ensure timely interventions for IV‐to‐PO antibiotic conversion.