Title: Implementation of Prescriber Antibiotic Scorecards in a Rural Community Hospital
Authors: Valeriy Shipilov PharmD, Joshua Pruitt PharmD, BCIDP
Purpose: Antimicrobial stewardship is an essential practice component in acute care settings as about 30% of all antibiotics prescribed in U.S. acute care hospitals are unnecessary or suboptimal. Tracking and reporting of antimicrobial utilization are two core elements of stewardship programs and aid benchmarking, transparency, and accountability. Previous studies on implementation of antimicrobial utilization reports have limited data on efficacy of these interventions on prescribing trends. The purpose of this study is to implement and track the impact on provider prescribing habits in a rural community hospital.
Methods: This report was developed and implemented at a rural community hospital with an average daily census of 125. Prescriber antibiotic utilization will be tracked by determining the number of shifts worked by a prescriber and the number of broad-spectrum antibiotics prescribed in a month. Data will be tracked and analyzed with a reporting software available through the hospital's electronic health record. Broad spectrum antibiotics will be defined as cefepime, meropenem, levofloxacin, and piperacillin-tazobactam. Broad spectrum antibiotic utilization will be reported to providers monthly as a rolling average of the number of targeted antibiotics prescribed per shift worked. Prescribers will be privately provided with their randomized identification number in an effort to blind data of their peers.
Results: We saw a statistically significant reduction in antibiotics prescribed per shift over time after the intervention (p = 0.019). There was no trend observed that was independent of the intervention (p=0.951) and there was no statistically significant immediate effect based on the intervention (p=0.076). We did not see a statistically significant reduction in days of therapy for targeted antibiotics (p=0.191) after the implementation of the scorecard.
Conclusions: Overall, we saw a statistically significant reduction in antibiotics prescribed per shift after the implementation of our prescribing scorecard. Although there was no effect on days of therapy, the results support the use of antibiotic scorecards as a means of tracking and reporting prescribing habits to physicians. Additionally, the reduction in use of broad-spectrum antibiotics has allowed us to meet quality goals for antibiotic prescribing, and we hope to expand the scope of the report to target reduction in days of therapy and possibly intravenous to oral switching.
Contact Information: [email protected]
