Category: Antimicrobial Stewardship: Program Development and Implementation

Poster Session: Antimicrobial Stewardship: Program Development and Implementation

180 - Leveraging the Electronic Medical Record as a Method of Antibiotic Stewardship

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Presenting Author(s)

Christina M. Kaul

Infectious Diseases Fellow
NYU Grossman School of Medicine
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

EM

Eric Molina

Medical Student
Baylor College of Medicine
Houston, Texas
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DA

Donna Armellino

RN, DNP, VP Infection prevention Northwell Health System
Northwell Health System
Manhasset, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Mary Ellen Schilling

Vice President, Infection Control
Northwell Health
New Hyde Park, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MJ

Mark Jarrett

Chief Quality Officer and Deputy Chief Medical Officer
Northwell Health
New Hyde Park, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Overutilization of antibiotics remains an issue in the inpatient setting. What is more, many protocols geared toward curbing improper antibiotic use rely heavily on resource- and personnel-intensive interventions. Thus, the potential for using the EMR to facilitate antibiotic stewardship remains largely unexplored.

Methods: We implemented a novel change for ordering certain antibiotics in our EMR: ceftriaxone, daptomycin, ertapenem, imipenem, meropenem, and piperacillin-tazobactam. When ordering one of these antibiotics, providers had to note a usage indication, which assigned a usage duration as per our Antibiotic Stewardship Committee guidelines. Pre-intervention, manual discontinuation was required if a provider did not enter a duration. The intervention was enacted August 2019 in 13 hospitals. Data was collected from January 2018 to February 2020. Antibiotic usage was reported monthly as rate per 1000-patient days. Monthly pre- and post-intervention rates were averaged, respectively. Paired samples t-tests were used to compare pre- and post-intervention rates per unit type per hospital. A p-value of less than 0.05 was considered significant. Units with minimal usage, as defined by a pre- or post-intervention mean of 0, were excluded from analysis.Example of Ordering an Antibiotic Prior to Intervention

Example of Ordering an Antibiotic After Intervention

Results: Ertapenem was noted to have a statistically significant decrease in utilization in seven units at three hospitals. Piperacillin-tazobactam was found to have a decrease in utilization in 19 units at eight hospitals. Daptomycin was found to have a decrease in utilization in one unit. Significant decreases in the utilization of ceftriaxone, imipenem, and meropenem were not noted.Example of Statistically Significant Decreased Utilization in Piperacillin-Tazobactam on a Medical-Surglcal Unit

Conclusion: Our study showed a statistically significant decrease in use of ertapenem, piperacillin-tazobactam and daptomycin using a simple built-in EMR prompt that curtails provider error. This should allow for an increased ease of integration, as the protocol does not require a host of resources for maintenance. Of note is decreased utilization of piperacillin-tazobactam and ertapenem across multiple hospitals, most notably on the medical and surgical wards. Thus, usage of the EMR without personnel-intensive protocols is a viable method for augmenting antibiotic stewardship in health systems.