3062 — Antimicrobial Stewardship Activities within VA in 2012

Graber CJ, VA Greater Los Angeles; Chou AF, Oklahoma City VA; Jones MM, Salt Lake City VA; Zhang Y, Salt Lake City VA; Goetz MB, VA Greater Los Angeles; Madaras-Kelly K, Boise VA; Kelly AA, VHA National Infectious Diseases Service; Samore MH, Salt Lake City VA; Glassman PA, VA Greater Los Angeles;

Objectives:
Encouraging appropriate antimicrobial prescribing via antimicrobial stewardship (AS) programs improves patient safety and promotes cost-effective care delivery. This study aims to (1) report on organizational characteristics of AS from a 2012 VA Healthcare Analysis and Informatics Group survey on AS activities administered to all 130 acute-care facilities; and (2) identify associations between key organizational characteristics and antibiotic use in patients admitted for non-infectious etiologies.

Methods:
Frequency statistics for key stewardship characteristics were compiled and bivariate analyses were conducted to estimate associations between AS characteristics and antibiotic days of therapy (DOT)/ 1000 bed days of care in a population of patients without infectious-related principal diagnoses.

Results:
Thirty-eight-percent of facilities had a formal AS team, most commonly directed by an Infectious Diseases (ID) physician (44%) or clinical pharmacist/clinical pharmacy specialist (CP/CPS) (21%); 69% of AS teams had a CP/CPS with ID training. Seventy-nine-percent of all facilities had an internal inpatient ID consultation service. Ninety-two percent of facilities reported having restrictions on antibiotic use. Seventy-four-percent had written antimicrobial clinical pathways/guidelines, and 42% had at least one antibiotic-specific order set. Thirty-percent of facilities "usually" or "always" addressed antibiotic de-escalation. Forty-three percent had procedures to review positive blood cultures. Seventy-two-percent offered antimicrobial education on antimicrobial use and 88% used the Computerized Patient Records System to facilitate stewardship activities. In bivariate analyses, there was an association between decreased antibiotic use and degree and duration of physician and pharmacy involvement in the AS team (p = 0.008), ID fellow/physician involvement in antibiotic approvals (p = 0.047), CP/CPS with ID training (p = 0.002), availability of inpatient ID consultation (p = 0.04), number of antibiotic-specific order sets (p = 0.03), and systematic de-escalation review (p = 0.007).

Implications:
Despite only 38% of facilities having a formal AS team, many AS components were common across VA facilities, a number of which were associated with reduced antibiotic use, particularly those associated with ID training.

Impacts:
Describing the current state of stewardship activities and their impact on antibiotic use informs the development of strategies and resource allocation to promote appropriate antimicrobial use and patient safety.