122 The Impact of a Proactive Computerized Physician Order Entry Antibiotic Stewardship Program (CPOE-ASP) on Tigecycline and Linezolid Use in a Community Hospital

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
John Leander Po, MSc, MD, PhD , Banner Estrella Medical Center, Phoenix, AZ
Jackie L. Dix, PharmD, BCPS , Banner Estrella Medical Center, Phoenix, AZ
Bao Nguyen, PharmD, BCPS , Banner Estrella Medical Center, Phoenix, AZ
Mary Martin, PharmD , Banner Estrella Medical Center, Phoenix, AZ
Background: Several strategies have been described regarding the implementation of an antibiotic stewardship program (ASP) such prior authorization, prescriber feedback and education, and antibiotic order forms. However, little is known about the effectiveness of implementing an ASP using a proactive computerized physician order entry (CPOE) system within a community hospital.
Objective: To assess the impact of tigecycline and linezolid use by implementing a proactive, computerized physician order entry antibiotic stewardship program (CPOE-ASP) in the community hospital setting.
Methods: A CPOE-ASP was designed for a 200 bed community hospital over an existing system in which tigecycline and linezolid ordering was guided through an on-screen, clinical decision support for physicians. Utilization of these antibiotics were based on FDA-approved indications within the context of limited its use to: 1) multidrug resistant organisms with no other options, 2) penicillin or vancomycin anaphylaxis with no other options, 3) second line therapy for pneumonia, urinary tract infections, and staphylococcal infections, and 4) recommendations of alternative antibiotics along with hyperlinks to evidence-based articles. The number of orders for tigecycline and linezolid were monitored, and a medication utilization evaluation (MUE) for tigecycline was performed pre and post intervention.  Chi square analysis as performed to assess statistical significance.
Results: The number orders placed for both tigecycline and linezolid in the four months prior to implementing CPOE-ASP were 34 and 176, respectively. In the four months following implementation, the number of tigecycline and linezolid orders decreased to 12 and 59, respectively. During pre and post-evaluation periods, the average daily hospital census were 151 and 174 patients, respectively. The MUE of tigecycline was also performed, demonstrating 3 out of 34 orders (8.8%) were considered appropriate during the pre-intervention period. Examples of inappropriate tigecycline use included empiric peri-operative antibiotic prophylaxis and gastroenteritis, the use of tigecycline when a single, narrow spectrum antibiotic was appropriate (i.e. vancomycin), and tigecycline use in patients without a penicillin allergy. In contrast, post CPOE-ASP implementation revealed 11 out of the 12 orders placed were considered appropriate (91.6%, p < 0.005). The single inappropriate order was made for a post-colectomy patient with fever and negative blood cultures, without documentation of a penicillin allergy.
Conclusions: Implementation of a pro-active CPOE-ASP for tigecycline and linezolid has led to a decrease in prescriptions of these two medications and a significant increase in the appropriate use of tigecycline. The CPOE-ASP can serve as a model for other anti-microbial agents.