245 - The impact of patient safety report and sentinel events on the prescribing and practice habits of infectious disease physicians

Background: Adverse events associated with antimicrobials range from mild to severe and may cause distress or harm to patients, and anxiety for prescribers. The basic tenets of prescribing antimicrobials are based on knowledge of the disease, pharmacokinetics, and pharmacodynamics of the prescribed agent, and effectiveness of the therapy.  Inappropriate prescribing can increase costs and may cause reactions or the emergence of resistance. There is a paucity of published data on the prescribing habits of physicians after a sentinel event or patient safety report. Thus, we carried out this study to ascertain whether patient safety reports and sentinel events influence physician antimicrobial prescribing practices

Methods: We invited Infectious Disease physicians at the University of Florida to participate in a survey of their perception of risks and prescribing habits after a sentinel event. Participants were interviewed using a standardized questionnaire.  Data were analyzed using Epi Info statistical software. Thematic analyses were performed on the open-ended interview questions.

Results: Of 17 faculty and fellows who participated in the survey, 5 (29.4%) had been practicing infectious disease for 1-3 years, 3 (17.6%) for 4-6 years, 2 (11.7%) for 7-9 years, and 7 (41.1 %) for >nine years. Two (11.7%) had a patient safety report filed against them. All participants had experienced at least one sentinel event involving an antimicrobial agent. Sixteen (94%) changed their practice after sentinel events; 8 (47%) increased the frequency of ordering laboratory tests, and 7 (41%) indicated they might change to more expensive antimicrobials with better safety profiles.  Eight (47%) participants endorsed hypervigilance when using antibiotics

Conclusion: We found that sentinel events affect physicians’ prescribing practices and monitoring of  antimicrobial therapy. The most frequent changes included closer follow-up and obtaining more  laboratory tests. However, some participants avoided certain antimicrobial agents or used more expensive therapies with better safety profiles. Although physicians use evidence-based medicine to alter their prescribing habits, serious adverse events can have an impact on the way we practice