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Pharmacy and Pharmaceutical Sciences
• Fifty percent of antibiotics prescribed in the outpatient setting are unnecessary1. •Outside of unnecessary prescribing, the antibiotics chosen can be incorrect with an inappropriate duration of therapy1. •It has been estimated that resistant infections affect nearly 3 million Americans annually and are the cause of 35,000 deaths each year with added costs up to $33.2 billion dollars1. •The Centers for Disease Control (CDC) recommends that outpatient antimicrobial stewardship programs identify “high priority conditions.” •Examples of high priority conditions include acute respiratory infections, urinary tract infections (UTI)and skin and soft tissue infections (SSTI).2 •Antibiotics are not associated with a diagnosis code and no specific guidance provided on duration in EHR •Providence St. Joseph Health (PSJH) created an outpatient antimicrobial stewardship guideline to assist with prescribing practices of antimicrobials in the outpatient setting. This guideline will be integrated into the electronic health record (EHR) at order entry. •The PSJH guidelines are based on guideline directed therapy by Infectious Diseases Society of America (IDSA) and American Academy of Family Physicians (AAFP) among others.
• Study design •Retrospective/Prospective •Pre-intervention: November 2020 –January 2021 •Post-intervention: To be determined •Primary Outcome •Duration of therapy for uncomplicated UTIs measured in days •Secondary Outcome •Percentage of appropriate prescriptions based on guideline directed therapy •Inclusion criteria •>18 years old •Diagnosis code of N.39 within the designated time frame at PMG primary care clinics and urgent/immediate care clinics •All encounter types: office visit, telephone, virtual, MyChart, orders only •Exclusion criteria •Antibiotics prescribed within 30 days at the time of index date •Patients who were/are pregnant at the time antibiotic prescription •Patients with complicated UTIs, chronic UTIs or pyelonephritis
• Antimicrobials were over-prescribed on average by the following amountof days for uncomplicated UTIs: • Beta-lactams: 0.8 days • Nitrofurantoin: 1.4 days •Trimethoprim/Sulfamethoxazole (TMP/SMX): 2 days •Fluroquinolones (FQN): 2.3 days •Based on a sample size of 100 patients: •Fifty-two percent of patients had allergies that affected treatment decisions which may lead to antibiotic challenge workflow/protocols •The prevalence of guideline directed antibiotic choice was 85% based on a sample size of 100 patients •The duration of therapy was inappropriate 70% of the time based on a sample size of 100 patients •Based on results from selective sample size, guideline tool could provide a decrease in duration of therapy especially for TMP/SMX and FQNs
• The guideline has not been uploaded due to system delays with pandemic •The sample selected for evaluating secondary outcomes was not randomized. Instead, patients were selected if they were prescribed an antibiotic that is not first-line or for a longer duration than generally recommended •Selective sample size to identify trends in prescribing patterns which lead to more TMP/SMX and FQN prescriptions •Ex: FQNs prescribed for 7 days •Ex: TMP/SMX prescribed for 5-7 days •A future limitation of this study is providers choosing to not utilize the guideline resulting in no change in prescribing patterns
• Collect data once EHR guideline is implemented to determine post-intervention prescribing patterns •An opportunity exists for clinic pharmacists to educate providers on UTI prescribing practices •Analyze results utilizing ANOVA statistical testing •Associate prescribed antibiotics with appropriate and accurate diagnosis codes
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2021
Providence Medical Group
Rubin, Kasey; Houshour, Chelsea; and Doran, Christine, "Assessing the effect of an electronic health record order entry guideline on duration of outpatientantimicrobial therapy prescribed for uncomplicated urinary tract infections" (2021). Providence Pharmacy PGY2 Program at Providence Medical Group 2021. 4.