Inpatient Prescription Research Articles

What guidelines?: Attitudes and behaviors for prescribing prophylactic hepatic encephalopathy medications.

What guidelines?: Attitudes and behaviors for prescribing prophylactic hepatic encephalopathy medications.

Nurse Practitioner Perspectives of Setting-Specific Opioid Prescribing Guidelines in Ontario: A Qualitative Study

Aim: To investigate the views of Nurse Practitioners (NPs) regarding the development of setting-specific opioid prescribing guidelines. Background: There has been a rise in opioid-related deaths and adverse events in Canada in recent years. Although NPs make up a significant opioid prescriber group, no Canadian setting-specific guidelines exist to help guide their opioid prescribing. Methods: Purposive sampling was used to select NPs practicing in inpatient settings. One-on-one semi-structured interviews were conducted virtually with 14 NPs (n=14) from Ontario. Directed qualitative content analysis was used to interpret interview data. Findings: The majority of NPs interviewed (n=13, 92.8%) believe that setting-specific opioid prescribing guidelines would benefit their practice. Interview responses illustrated that NPs face several challenges associated with inpatient opioid prescribing. To help mitigate these challenges, they often consult a pharmacist and reference prescribing resources such as Lexicomp and UpToDate. Additionally, several NPs in our study formulated their own setting-specific opioid prescribing resources to help guide their prescribing. Furthermore, NPs who had transitioned to acute care from a primary health care setting experienced a lack of confidence with opioid prescribing in a specialty setting. Conclusion: The development of setting-specific NP opioid prescribing guidelines in Canada can improve the prescribing process for NPs by providing them with clear, evidence-based recommendations, thus reducing ambiguity and promoting positive patient outcomes. Future research should explore the possibility of adapting internationally published setting-specific opioid prescribing guidelines for Canadian practice and the unique opioid prescribing challenges NPs experience when transitioning from primary care to acute care settings.

STOP Signs: A Population-based Interrupted Time Series Analysis of Antibiotic Duration for Complicated Intraabdominal Infection Before and After the Publication of a Landmark RCT.

To determine if the STOP-IT randomized controlled trial changed antibiotic prescribing in patients with Complicated Intraabdominal Infection (CIAI). CIAI is common and causes significant morbidity. In May 2015, the STOP-IT randomized controlled trial showed equivalent outcomes between four-day and clinically determined antibiotic duration. This was a population-based retrospective cohort study using interrupted time series methods. The STOP-IT publication date was the exposure. Median duration of inpatient antibiotic prescription was the outcome. All adult patients admitted to four hospitals in Calgary, Canada between July 2012 and December 2018 with CIAI who survived at least four days following source control were included. Analysis was stratified by infectious source as appendix or biliary tract (group A) versus other (group B). Among 4384 included patients, clinical and demographic attributes were similar before vs after publication. In Group A, median inpatient antibiotic duration was 3 days and unchanged from the beginning to the end of the study period [adjusted median difference -0.00 days, 95% confidence interval (CI) -0.37 - 0.37 days]. In Group B, antibiotic duration was shorter at the end of the study period (7.87 vs 6.73 days; -1.14 days, CI-2.37 - 0.09 days), however there was no change in trend following publication (-0.03 days, CI -0.16 - 0.09). For appendiceal or biliary sources of CIAI, antibiotic duration was commensurate with the experimental arm of STOP-IT. For other sources, antibiotic duration was long and did not change in response to trial publication. Additional implementation science is needed to improve antibiotic stewardship.

Evaluation of Inpatients Medication Prescribing Practice at Ibrahim Malik Teaching Hospital: A Descriptive Cross-sectional Study

Introduction: Prescribing errors account for almost 50% of medication errors and represent the eighth leading cause of death in the US. The current study aimed to evaluate inpatient prescribing practice by assessing adherence to prescription-writing guidelines and identifying the frequency and severity of drug-drug interactions (DDIs) and drug-disease interactions (DDSIs). Methods: An observational-descriptive cross-sectional study was conducted among inpatient wards in Ibrahim Malik teaching hospital, Khartoum, Sudan. Total coverage sampling was performed and the sample size consisted of 132 prescriptions containing a total of 700 prescribed drugs. The data were collected from patients’ files, and the completeness of prescriptions was assessed according to national and international guidelines. Drug interactions were checked by the interaction checker of www.drug.com. Results: The overall prescription completeness was 0%, and the completeness of both prescriber data and medication data were 1.5%, (0.4% for Intravenous [IV] and 0.6% for non-IV drugs), respectively. The most missing elements of the prescription were duration and qualification. Moreover, only 25% of the prescribed drugs were written in the Prescription and Medication Administration Record or drug chart, but the rest were written elsewhere within the patient’s file. The prescriptions containing DDIs and DDSIs were 49.2% and 46.2%, respectively, ranging from major (9.1%), moderate, (40.9%), and minor (28%) for DDIs, major (30.3%), moderate (33.3%), and minor (0.8%) for DDSIs. The highest percentage of drug interactions was found in the internal medicine ward. Diabetes was significantly associated with both DDIs (P = 0.003) and DDSIs (P = 0.031). Conclusion: The findings of this study reflect a real problem in prescribing practice, as no prescription was considered to be complete, and nearly half of the patients were exposed to DDIs and/or DDSIs.

Hospital information system-based pharmacovigilance for elderly patients: practices and results.

To evaluate the effect of a pharmacovigilance system on potentially inappropriate medication prescriptions for elderly patients. The retrospective study was conducted at Shaanxi Provincial People's Hospital, China, after approval from the ethics review committee, and comprised data from May 2020 to April 2021, and comprised prescriptions related to elderly patients aged at least 65 years. Number of medication risk assessment entries, number of intervened medical orders on outpatients and inpatients number of medical order prompts, and number of physician communication with prescription-checking pharmacists were noted. Potential drug interaction rate was compared between pre- implementation from May to October 2020 and post-implementation from November 2020 to April 2021. Besides, the usage of sedatives and hypnotics and potentially inappropriate medication was noted for the period from January to June 2021 to evaluate the sustained effect of pharmacovigilance system. Data was analysed using SPSS 19. A total of 118 drugs were involved in the 3911 entries of outpatient prescription warnings, of which 19 drugs accounted for 3156 (80%). Besides, a total of 113 drugs were involved in the 3999 entries of inpatient prescription warnings, of which 19 drugs accounted for 3199 (80%) The overall prevalence of potentially inappropriate medication related to sedatives and hypnotics decreased post-intervention as warning percentage was 16.1% in January and 6.7% in June among outpatients. On inpatients, the warning percentage was 30.6% in January and 6.1% in June. The pharmacovigilance system could reduce potentially inappropriate medication and provide deeper technical support for the safety of medical behaviour and individualised treatment of patients.

Promoting generic drug usage in Japan: correlation between generic drug usage and monthly personal income

BackgroundTo reduce pharmacy-related medical expenses, it is necessary to cut drug costs, potentially by increasing generic drug usage. This study analyzes the correlation between generic drug usage and monthly personal income by examining prescriptions for individual drugs.MethodsWe conducted a cross-sectional study based on the data set from the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan and the Basic Survey on Wage Structure. We calculated the correlation coefficient between the usage rate of generic drugs in each prefecture of Japan and monthly personal incomes. We then analyzed the correlation coefficients based on the therapeutic categories of medicinal drugs; the contingency table was visualized as a mosaic plot. To compare the proportions between multiple categories, the chi-squared test was applied as a statistical significance test that was used in the analysis of n × m contingency tables. We worked with the null hypothesis that there were no differences between classes in the population.ResultsRegarding the correlation coefficient between the usage rate of generic drugs and monthly personal incomes, the proportion of negative correlation coefficients for outpatient out-of-hospital and outpatient in-hospital prescriptions was over 70%, while that for inpatient prescriptions was 46.9%. The proportion of medicinal drugs exhibiting a negative correlation between the rates of generic drug usage and monthly personal incomes for outpatient out-of-hospital prescriptions and outpatient in-hospital prescriptions was higher than that of inpatient prescriptions. The proportion of statistically correlated medicinal drugs among inpatient prescriptions was lower than that among outpatient out-of-hospital and outpatient in-hospital prescriptions. The proportions of significant negative correlations for outpatient out-of-hospital, outpatient in-hospital, and inpatient prescriptions were 30.6%, 22.7%, and 3.5%, respectively. It was also observed that the rate of generic prescription usage for outpatient out-of-hospital and in-hospital prescriptions increased as monthly personal incomes decreased. In outpatients, the therapeutic categories with strong negative correlations were vasodilators and hyperlipidemia drugs.ConclusionsOur results may help to increase the usage rate of generic drugs in different prefectures by providing useful information for promoting them throughout Japan.

Off-Label Prescribing in Paediatric Cardiology: Regulatory Aspects and Safety Assessment by Spontaneous Reporting

In paediatrics, it is a common practice to use pharmaceuticals outside the approved Summary of Product Characteristics (i.e. off-label). According to the literature, up to 45% of inpatient paediatric prescriptions and 10–20% of outpatient ones are for off-label uses. It is essential to analyse such uses, as it helps medical practitioners act reasonably and professionally. The aim of the study was to explore the possibility of using spontaneous reports to assess the risks of the off-label use of cardiac medicinal products in children in the Irkutsk region. Materials and methods . The authors analysed 25 reporting forms on adverse drug reactions (ADRs) in paediatric cardiac patients from the database of the Regional Centre for Drug Safety Monitoring of the Irkutsk Region and regional data from the Automated Information System (AIS) of the Federal Service for Surveillance in Healthcare of the Russian Federation (Roszdravnadzor) submitted in 2009–2020. The inclusion criterion for reporting forms was a causal relationship between the off-label use of a medicinal product and the ADR that was scored as “possible” or higher on the Naranjo probability scale. Results . According to the reporting forms, the off-label use of cardiac medicinal products in children was associated with ADRs, such as angiooedema, cutaneous symptoms, and bronchospasm. The majority of ADRs (84%) were considered severe. The medicinal products were prescribed for heart failure, arterial hypertension, and cardiac arrhythmias. The majority of ADR reports (75%) were submitted by inpatient medical organisations. Conclusions . The analysis of spontaneous ADR reporting databases is a simple and informative method for studying the safety of medicinal products. It is necessary to raise awareness of ADRs associated with off-label prescribing amongst paediatric cardiologists in order to reduce the incidence of ADRs. The following contributions will improve the quality of medical care: all parties involved with pharmaceuticals should adhere to good pharmacovigilance practices, medical practitioners should be actively involved in treatment safety monitoring, and the professional training curricula of paediatric cardiologists and paediatricians should include specific units on the practical functioning of pharmacovigilance.

Renally inappropriate medications in elderly outpatients and inpatients with an impaired renal function

ABSTRACT Background and aims The purpose of this study was to investigate differences in the frequency of renally inappropriate medications (RIMs) in outpatient and inpatient among three institutions. Methods We collected prescription and renal function data for patients over 65 years of age from the drug department system. We selected 50 kinds of the most frequently used medicines which require dose adjustment according to a patient’s renal function. Results Outpatient RIM was seen in 611 cases (6.17%), and inpatient prescription RIM was seen in 317 cases (5.29%), showing a significant difference between the groups (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.02–1.35). However, in a multivariate analysis, when the renal function was included, that difference between outpatients and inpatients became insignificant (OR 1.16, 95% CI 0.98–1.37). The distribution of prescription with or without RIM in outpatient and inpatient settings depended on the CKD stage. Outpatients with a better CKD stage (stage 1–3) had a higher rate of RIM than inpatients, while patients with a worse CKD stage (stage 4 or 5) had a higher rate of RIM than outpatients. Conclusion The rate of RIM in outpatients tends to be high, and attention should be paid to RIM in inpatients with a severe CKD stage.

Changes in inpatient medicine prescribing during COVID-19 lockdown.

New Zealand went into lockdown March 2020 successfully eliminating the circulation of the coronavirus disease 2019 (COVID-19) virus. During lockdown there were reduced rates of respiratory infections and hospital admission numbers were low. At the time, rumours of benefit and harm of medicines for COVID-19 were widespread in the lay and medical media. To describe changes in inpatient prescribing in an acute general medicine service during the New Zealand COVID-19 lockdown in 2020. Rates of prescribing of medicines during the 33 days of lockdown were compared with a 33-day control period before lockdown. Prescriptions, patients and bed days were calculated from the hospital patient administration and electronic prescribing and administration systems. In the general medicine service, acute admissions were 20% lower during lockdown (from 1216 pre-lockdown to 974). There was a small decrease in the rate of prescriptions per patient (10.1 vs 10.4, P = 0.01) during lockdown, and the average length of stay was shorter (3.2 vs 3.6 days). Nebulised administration decreased by 75% (1.3% vs 5.3% of admissions) but unexpectedly there was no change in the prescribing rates of antibacterial medicines, e.g.amoxicillin (26% vs 26%). There were no changes in rates of prescribing of medicines being rumoured to potentially improve (e.g. hydroxychloroquine) or worsen (e.g. angiotensin-converting enzyme inhibitors) COVID-19 outcomes. Acute medical admissions decreased 20% during lockdown for COVID-19, with a proportional decrease in prescriptions. Reduced rates of respiratory tract infections did not lead to decreased prescribing of antibacterial medicines. Rumour-based prescribing did not eventuate.

Drug Utilization Study of Gastroprotective Agents in Medicine and Surgery Wards of a Tertiary Care Teaching Hospital.

Introduction Drug utilization research (DUR) is "the marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences" as per the definition of the World Health Organization (WHO). The ultimate goal of DUR is to evaluate whether the drug treatment is rational or not. Various gastroprotective agents are available today, such as proton pump inhibitors, antacids, and histamine 2A receptor antagonists (H2RAs). Proton pump inhibitors block the gastric H+/K+-adenosine triphosphatase (ATPase) via covalent binding to cysteine residues of the proton pump to inhibit gastric acid secretion. Antacids are compounds containing different combinations, such as calcium carbonate, sodium bicarbonate, aluminum, and magnesium hydroxide. Histamine 2A receptor antagonists (H2RAs) decrease gastric acid secretion by reversibly binding to histamine H2 receptors located on gastric parietal cells, thereby inhibiting the binding and action of the endogenous ligand histamine. A recent literature review has shown that inappropriate use of gastroprotective agents has increased the risk for adverse drug reactions (ADRs) and drug interactions. Methods A total of 200 inpatient prescriptions were analyzed. The extent of prescribing, dosing information given, and cost incurred on the use of gastroprotective agents in both surgery and medicine inpatient departments was assessed. Prescriptions were also analyzed using WHO core indicators and for drug-drug interactions. Results Proton pump inhibitors were prescribed to 112 male patients and 88 female patients. The most common diagnosis was diseases of the digestive system with 54 (27.5%) cases, followed by diseases of the respiratory tract with 48 (24%) cases. Out of 200 patients, 51 comorbidities were reported from 40 patients. Among all prescriptions, injection of pantoprazole was the most common route of administration (181 (90.5%)),followed by tablets of pantoprazole (19 (9.5%)). The most common dose prescribed of pantoprazole was 40 mg in 191 (95.5%)patients in both departments. The frequency of therapy was also most commonly prescribed twice daily (BD) in 146 (73%) patients. Potential drug interaction was most commonly found with aspirin in 32 (16%) patients. The total cost incurred on proton pump inhibitor therapy of the medicine and surgery departments was 20,637.4 Indian Rupees (INR). Of this, the cost for patients admitted in the medicine ward was 11,656.12 INR and in the surgery department was 8,981.28 INR. Conclusion Gastroprotective agents are a group of drugs that are used to protect the stomach and the gastrointestinal tract (GIT) from acid-related injury. Our study found that proton pump inhibitors were the most commonly prescribed gastroprotective agents among inpatient prescriptions, with pantoprazole being the most frequently used. The most common diagnosis among patients was diseases of the digestive system, and most of the prescriptions were for injection administration at a dose of 40 mg twice daily. These findings suggest that there may be opportunities for improvement in the rational use of gastroprotective agents to reduce the risk of adverse drug reactions and interactionsand lower healthcare costs. Overall, the study highlights the need for healthcare providers to be aware of the appropriate use of gastroprotective agents to minimize irrational prescriptions and reduce polypharmacy.

Development of Quality Indicators to Evaluate the Appropriateness of Empiric Antimicrobial Use in Pediatric Patients.

Use of quality indicators is one strategy recommended to assess antimicrobial prescribing for pediatric inpatients. To achieve consensus from infectious diseases clinicians on quality indicators that characterize appropriate empiric antimicrobial use for the management of infectious syndromes in pediatric inpatients. This study was completed using the Delphi technique. The research team developed an initial list of quality indicators, informed by a literature search. A multidisciplinary group of health care providers with expertise in infectious diseases was invited to participate. The list was disseminated to this panel of experts using Opinio survey software. The experts were asked to rate the indicators on a 9-point Likert scale in relation to the following criterion: "The importance of each item in determining appropriateness considering benefit or harm at the individual or population level". Consensus was defined as at least 75% agreement and a median score of 7 or higher. Twelve of 31 invited experts completed at least 1 round of the survey, and 10 completed all rounds. Consensus was achieved on 28 of 31 proposed indicators after 3 rounds. Indicators with consensus were categorized under "empiric choice" (n = 12 indicators), "dose" (n = 5), "duration" (n = 2), "administration" (n = 4), "diagnosis" (n = 2), and "documentation" (n = 3). Six of the indicators for which consensus was achieved were rephrased by the experts. Consensus was achieved on quality indicators to assess the appropriateness of empiric antimicrobial use in pediatric patients. Clinicians and researchers can use these consensus-based indicators to assess adherence to best practice.

Description the completeness of prescriptions for inpatients at the Pharmacy Installation HKBP Balige General Hospital period of July 2020

Prescription is a written request from a doctor to a pharmacist to provide drugs for patients written in the prescription. For in accordance with applicable laws and regulations to minimize irrational use of drugs and preventmedication errors for patient safety purposes. The purpose of this study was to describe Description the completeness of prescriptions for inpatients at the Pharmacy Installation HKBP Balige General Hospital period of July 2020. The design of this study was descriptive, with a sample of 186 prescriptions, using a cluster random sampling technique. The results showed that 46.2% of prescriptions at the Balige HKBP RSU for the July 2020 period were complete and 53.8% incomplete. Of the total 186 prescription sheets, the information on the doctor's name (27.4%), the doctor's initial (5.9%), the patient's name (0.5%), the patient's address (36.6%), the instructions for use (10,2%). This shows that the completeness of the recipe at RSU HKBP Balige is not complete. Incomplete prescriptions occur because many visiting patients increase the busyness of the prescriber, so doctors do not have time to write a complete prescription. It is recommended to the management of RSU HKBP Balige to put more emphasis on doctors to complete prescriptions, so that TTK does not find incomplete prescriptions anymore.

Antibiotic use in hospitalized patients with COVID-19: a population-based study in Hong Kong.

Hong Kong experienced four epidemic waves caused by the ancestral strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020-2021 and a large Omicron wave in 2022. Few studies have assessed antibacterial prescribing for coronavirus disease 2019 (COVID-19) inpatients throughout the pandemic. To describe inpatient antibacterial prescribing and explore factors associated with their prescription. Electronic health records of patients with COVID-19 admitted to public hospitals in Hong Kong from 21 January 2020 to 30 September 2022 were used to assess the prevalence and rates of inpatient antibacterial drug use (days of therapy/1,000 patient days [DOT/1,000 PD]). We used multivariable logistic regression to investigate potential associations between patients' baseline characteristics and disease severity and prescription of an antibacterial drug during hospital admission. Among 65,810 inpatients with COVID-19, 54.0% were prescribed antibacterial drugs (550.5 DOT/1,000 PD). Compared to waves 1-2 (46.7%; 246.9 DOT/1,000 PD), the prescriptions were lowest during wave 4 (28.0%; 246.9; odds ratio (OR): 0.39, 95% CI: 0.31-0.49) and peaked in early wave 5 (64.6%; 661.2; 0.82, 0.65-1.03). Older age (≥80 years: OR 2.66, 95% CI, 2.49-2.85; 60-79 years: 1.59, 1.51-1.69, compared with 20-59 years), more severe disease (fatal: 3.64, 3.2-4.16; critical: 2.56, 2.14-3.06, compared with severe), and COVID-19 vaccine doses (two doses: 0.74, 0.69-0.78; three doses: 0.69, 0.64-0.74; four doses: 0.52, 0.44-0.62, compared with unvaccinated) were associated with inpatient antibacterial drug use. Antibacterial prescribing changed over time for hospitalized patients with confirmed COVID-19 and was potentially related to patients' demographics, medical conditions, and COVID-19 vaccination status as well as healthcare capacity during epidemic waves.

Antibiotic Evaluation Use towards Diabetic Foot Ulcer Inpatient at Hospital in Surakarta

A diabetic foot ulcer is one of diabetes mellitus type 2 complications indicated by open sores. Because it contains bacteria, it is treated with antibiotics. Improper use of antibiotics could harm patients due to the length of wound healing. This study aims to determine the appropriate of antibiotics in patients with a diabetic foot ulcers. This is a non-experimental research with descriptive analysis approach. The medical records of diabetic foot ulcer patients undergoing inpatient and antibiotic prescribing are observed. The data obtained were analyzed by comparing the use of antibiotics based on the National Health Service guidelines, the Indonesian National Drug Information, and the Drug Information Handbook. The results of this study showed antibiotics used are metronidazole (4.8%), vancomycin (4.8%) and antibiotics combination are ceftriaxone-metronidazole (47.6%), ceftriaxone-metronidazole-clindamycin (4,8%), levofloxacin-azithromycin-ceftriaxone (4.8%), cotrimoxazole-ciprofloxacin (4.8%), metronidazole-meropenem (4.8%), ceftriaxone-metronidazole-gentamicin (4.8%), metronidazole-clindamycin-ciprofloxacin (4.8%), ceftriaxone-levofloxacin (4.8%), and ceftriaxone-metronidazole-ciprofloxacin (9.5%). The evaluation results according to criteria appropriate usage of antibiotics that is 100% appropriate indication, 100% for appropriate of patients, 42.3% for appropriate drug, and 61.9% for the appropriate dose.

Prevalence and characteristics of antibiotic prescription for acute COVID-19 patients in Japan

COVID-19 is a viral infection and does not require antibiotics. The study aimed to elucidate a prescribing pattern of antibiotics for COVID-19. A nationwide cross-sectional study was conducted in Japan. The Diagnosis and Procedure Combinations (DPC) data was used to collect information, covering 25% of all acute care hospitals in the country. In 140,439 COVID-19 patients, 18,550 (13.21%) patients received antibiotics. Antibiotics were prescribed more often in inpatients (10,809 out of 66,912, 16.15%) than outpatients (7741 out of 73,527, 10.53%) (p < 0.001). Outpatient prescription was significantly associated with older patients (odds ratio [OR], 4.66; 95% confidence interval [CI] 4.41–4.93) and a greater Charlson index (OR with one-point index increase, 1.22; 95% CI 1.21–1.23). Inpatient prescription was significantly associated with older patients (OR 2.10; 95% CI 2.01–2.21), male gender (OR 1.12, 95% CI 1.07–1.18), a greater Charlson index (OR with one-point increase, 1.06; 95% CI 1.05–1.07), requirement of oxygen therapy (OR 3.44; 95% CI 3.28–3.60) and mechanical ventilation (OR 15.09; 95% CI 13.60–16.74). The most frequently prescribed antibiotic among outpatients was cefazolin, while that among inpatients was ceftriaxone. Antibiotic prescription is relatively low for acute COVID-19 in Japan. Antibiotic prescription was associated with older age, multi-morbidity, severe disease, and winter season.

Evaluation of Policies Limiting Opioid Exposure on Opioid Prescribing and Patient Pain in Opioid-Naive Patients Undergoing Elective Surgery in a Large American Health System.

Overprescribing to opioid-naive surgical patients substantially contributes to opioid use disorders, which have become increasingly prevalent. Opioid stewardship programs (OSPs) within healthcare settings provide an avenue for introducing interventions to regulate prescribing. This study examined the association of OSP policies limiting exposure on changes in surgery-related opioid prescriptions and patient pain. We evaluated policies implemented by an OSP in a large American healthcare system between 2016 and 2018: nonopioid medication during surgery, decrease of available opioid dosage vials in operating rooms, standardization of opioid in-patient practices through electronic health record alerts, and limit to postsurgery opioid supply. Generalized linear mixed effects models examined the association of interventions with outcome changes in 9262 opioid-naive patients undergoing elective surgery. Outcomes were discharge pain, morphine milligram equivalent in the first prescription postsurgery, and opioid prescription refills. Decreases in all prescription outcomes and discharge pain were observed following onset of OSP interventions ( P 's < 0.001). Among individual policies, standardization of in-patient prescribing practices was associated with the strongest decrease in prescribed morphine milligram equivalent. Importantly, there was no evidence of an increase in discharge pain related to any intervention. This study promotes the potential of OSP formation and policies to reduce opioid prescribing without compromising patient pain. The most effective policy, standardization of in-patient prescribing practices through alerts, suggests that reminding prescribers to re-evaluate the patient's need is effective in changing behavior. The findings offer considerations for OSP formation and policy implementation across health systems to improve quality and safety in opioid prescribing.

1812. Impact of removing ESBL testing report on the selection of antibiotics for the treatment and 30-day mortality of patients infected with ESBL-producing organisms

Abstract Background The rising burden of carbapenem-resistant organisms is well recognized as a global crisis. Several studies have identified preceding carbapenem use as a risk factor for the subsequent development of infections with carbapenem-resistant, gram- negative organisms. We characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing. Methods A historical control study, interventional analysis study was conducted at Ramathibodi Hospital) to compared 1 year before removal ESBL designation (period1, August 1, 2019 to July 31, 2020) and 1 year post removal ESBL designation (period 2, August 1, 2020 to July 31, 2021) on inpatient antibiotic prescribing. Categorical variables were compared using the Fisher exact test. Continuous variables were evaluated using the Wilcoxon rank-sum test. All statistical tests were 2-tailed, and a P &amp;lt; .05 was considered statistically significant. Results The primary outcome definitive prescribing of carbapenems decreased from 56.5% to 41.3% afterward (P= .01). Prescription of cefepime was also decreased from 13.6% to 3.5% (P&amp;lt; .05), respectively. Whereas piperacillin-tazobactam use significantly increased from 10.4% to 28.7% (P&amp;lt; .05). Trimethoprim-sulfamethoxazole was prescribed more frequently, i.e., increased from 0 to 2.8%, but this change was not statistically significant. The secondary outcome 30-day mortality from any cause was no different between the two groups, with 22 of 154 patients (14.3%) in group 1 and 24 of 143 (16.8%) in group 2 (P = .55). Conclusion Definitive prescribing of carbapenems was decreased and β-lactam–β-lactamase inhibitor combination was increased after removal ESBL report. Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs. Disclosures All Authors: No reported disclosures.

Association of QT interval-prolonging drugs with clinical trial eligibility in patients with advanced cancer.

Drug-induced prolongation of the heart rate-corrected QT interval (QTc) is associated with increased risk for the potentially fatal arrhythmia torsades de pointes. Due to arrhythmia risk, clinical trials with cancer therapeutics often exclude patients based on thresholds for QTc prolongation. Our objective was to assess associations between prescriptions for QT-prolonging drugs and the odds of meeting cancer trial exclusionary QTc thresholds in a cohort of adults with advanced cancer. Electronic health records were retrospectively reviewed for 271 patients seen at our institutional molecular solid tumor clinic. Collected data included demographics, QTc measurements, ventricular arrhythmia-related diagnoses, and all inpatient and outpatient prescriptions. Potential associations were assessed between demographic and clinical variables, including prescriptions for QT-prolonging drugs, and QTc measurements. Women had longer median QTc measurements than men (p = 0.030) and were prescribed more QT-prolonging drugs during the study (p = 0.010). In all patients, prescriptions for QT-prolonging drugs were associated with longer median and maximum QTc measurements at multiple assessed time points (i.e., for QT-prolonging drugs prescribed within 10, 30, 60, and 90 days of QTc measurements). Similarly, the number of QT-prolonging drugs prescribed was correlated with longer median and maximum QTc measurements at multiple time points. Common QTc-related exclusionary criteria were collected from a review of ClinicalTrials.gov for recent cancer clinical trials. Based on common exclusion criteria, prescriptions for QT-prolonging drugs increased the odds of trial exclusion. This study demonstrates that prescriptions for QT-prolonging drugs were associated with longer QTc measurements and increased odds of being excluded from cancer clinical trials.

1779. An Assessment of Antibiotic Treatment Guideline Adherence for Common Infections in a Tertiary Care Hospital with an Established Antimicrobial Stewardship Program in Kathmandu, Nepal

Abstract Background Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. We aimed to assess the quality of inpatient antibiotic prescribing practices for common infections in a tertiary centre in Kathmandu. Methods We conducted a retrospective monocentric review of medical records of adult inpatients diagnosed with Urinary Tract Infection; Pneumonia; and Skin and soft tissue infection between January 2018 till December 2019. Adherence was defined as the prescription of antibiotics for mentioned infection fulfilling the correct choice, correct dose, and correct duration of therapy. Flow diagram 1 Medical Records Review to assess adherence to guideline Results Clinical records of 354 inpatients were included in the analysis. Overall, 37.9% of antibiotic prescriptions were adherent to guideline recommendations. The non-adherent groups also had a higher proportion of patients in the age group between 45 and 60 years (66%, OR: 1.87, 95% CI: 1.09-3.21, p=0.2) and with the presence of co-morbidities (58%, OR: 0.44, 95% CI: 0.26-0.75, p&amp;lt; 0.1). The department categories, gender, number of comorbidities, infectious disease diagnosis, and history of antibiotic drug allergy had no significant effect reported on adherence. Incorrect selection (20%, or: 0.24, 95% CI: 0.07-0.79, p=0.19) and incorrect antibiotic dosage (21%, OR: 0.26, 95% CI: 0.08-0.82, p=0.02) were prescribed among patients diagnosed with urinary tract infection. Likewise, an incorrect dosage of antibiotics (40%, OR: 0.27, 95% CI: 0.07-0.97, p=0.05) was prescribed for patients with pneumonia. Pneumonia (52%) and urinary tract infection (32%, p&amp;lt; 0.01) had more de-escalations, while the antibiotic spectrum prescribed was significantly broad (81%, p&amp;lt; 0.001). Study Schema Conclusion Our study revealed low adherence despite the availability of the updated guideline for an antibiotic prescription. These data demand an urgent need to confront the antibiotic prescription pattern in the tertiary care centres for tailored interventions to improve adherence to guidelines, particularly focusing on prescriptions of antibiotic types and in the elderly population. It is also an imperative to reduce the broad-spectrum antibiotic exposure to the patients with acute infections guided by the culture reports. Disclosures All Authors: No reported disclosures.

Assessing safety of inpatient direct oral anticoagulant prescribing utilising an electronic prescribing system

Abstract Introduction Direct oral anticoagulants (DOACs) are favoured over oral vitamin K antagonists (VKA) due to their fixed-dose regimen and reduced thromboembolic and bleeding risk. Despite clear dose adjustments based on patient characteristics, several observational studies have demonstrated 15-20% of patients being overdosed or underdosed when compared to licensing.1,2 Inappropriate dosing can lead to harm e.g., bleeding or thrombosis which would prolong/escalate hospital stay. Aim To assess clinical appropriateness of inpatient DOAC prescriptions across multiple sites of a large London based NHS Trust. Methods This study was conducted retrospectively over a seven month-period across 4 sites from a large London based NHS Trust from November 2021. Electronic prescribing system was used to generate daily reports that enabled a specialist haematology pharmacist to assess all adult inpatient DOAC prescriptions for appropriateness as per product licensing for indication. The report included patient characteristics (age, gender, body weight), prescribed DOAC (agent, dose, indication), serum creatinine, hospital site. Queries were escalated for review by the pharmacy or medical teams. Type of intervention (dose, agent, or no change) was recorded, and allocated a clinical severity rating using IMPACCTS.3 This scale runs from a score of 1 indicating a good practice intervention to a score of 5 that prevents serious or major harm including death. This study was approved by the University College London (UCL) School of Pharmacy research ethics committee. Results A total of 1,761 inpatient DOAC prescriptions were reviewed, of which 10.1% had a clinical query requiring escalation. Results demonstrate that 77.0% (n=137) of all queries were dose-related, 33.2% overdosed and 43.8% underdosed compared to licensing, the most common agent requiring adjustment being apixaban. Renal-related queries were most frequently observed (50.6%), with 12.8% of patients on edoxaban having CrCl &amp;gt;110ml/min. We found that 2.3% of prescription queries raised required review and stopping antiplatelet agents co prescribed with anticoagulation. Most interventions made had a severity rating of 4 (74.2%), followed by 15.2%, and 10.7% had a score of 1 and 3, respectively. Following pharmacist recommendations, changes made were either dose (38.7 %) or agent (14.6%). Alternatively, it was not applicable due to a change in clinical status, i.e., renal function improved (1.1%) or patient re-weighed (6.2%). Changes to prescriptions did not apply to some patients as documentation of clinical reasoning were recorded (19.7%), or due to patients being discharged (13.5%). Discussion/Conclusion This study has demonstrated a significant number of DOAC prescriptions are inappropriate at the point of prescribing when compared to product summary of characteristics for the indications listed. The use of a centralised report to assess appropriateness of DOAC prescribing across several sites has facilitated a centralised mechanism led by a haematolgy specialist to improve safer DOAC prescribing. The most frequent interventions being made included dose amendments based on calculated creatinine clearance and amending (or adding) indications entered on the system. Further work is required to demonstrate effective change management strategies that have been implemented to further improve the safety of DOAC prescribing within the Trust.