P-919. Significant decline in Vancomycin Use and cost of therapy in Patients with Pneumonia with QI Informatics-based Antibiotic Stewardship Program (ASP) Interventions

TL;DR

An informatics-based antibiotic stewardship program significantly reduced vancomycin use and costs for pneumonia patients by automating MRSA screening orders.

Contribution

Implementation of an informatics-based ASP with automated nasal MRSA PCR screening orders significantly reduced vancomycin use and costs.

Findings

Vancomycin use decreased by 49.5% after implementing informatics-based ASP interventions.

The average cost of vancomycin per 1000 patient days dropped by 50%.

Nasal MRSA PCR screening ordering increased to 100% during the intervention period.

Abstract

According to CDC, vancomycin should be a key-target for ASP; and high negative-predictive-value of nasal MRSA PCR screening (nMP) for pneumonia has been shown.

Informatics-based ASP interventions were implemented at a tertiary-care-center serving the tristate area in Upper Midwest as current state/ Fishbone analyses showed that vancomycin-use for pneumonia is high and nMP are not being done as not easy to remember/order. SMART aim was to reduce vancomycin-use by 20% for pneumonia by 3/15/25. Automated Default nMP order was incorporated in Pneumonia order-set in EMR (Epic) while ordering vancomycin for Hospital Acquired pneumonia/Ventilator associated pneumonia on 10/7/24 and for Severe Community Acquired pneumonia meeting criteria for vancomycin on 11/4/24.Vancomycin-use during pre-intervention-period(P1: 4/1/24-9/30/24) was compared with intervention-period(P2: 10/15/24-3/15/2025).

Outcome measures (vancomycin duration; cost) showed a significant decline on XmR SPC charts (Figures 1 and 2). Average vancomycin use decreased by 49.5% (from 72.2 DOT/1000 patient days in P1 to 36.3 DOT/1000 patient days in P2, p< 0.01). Average Vancomycin drug inventory cost decreased by 50% (from 1089.5 USD/1000 patient days in P1 to 546.3 USD/1000 patient days in P2; p< 0.05). All Process measures showed a significant, sustained change: proportion of nMP ordering increased to 100% in P2 (p< 0.0001); proportion of negative PCR results leading to discontinuation of vancomycin increased by 84% (p< 0.01) and time to discontinuation of vancomycin declined by >50% (p< 0.05); balancing measures [readmissions and total time from order to PCR results] remained unchanged.

Informatics-based ASP interventions were highly transformative leading to a significant decline in total vancomycin utilization, considerable healthcare-cost savings and significant increase in nMP screening among patients hospitalized with pneumonia; and should be considered for implementation on a wider scale.

All Authors: No reported disclosures