236. Incorporating Clinical Guidance into Computerized Prescriber Order Entry May Reduce Fluoroquinolone Utilization for the Treatment of Diverticulitis at a Rural Community Health System

Background Fluoroquinolones are associated with many adverse effects. As a result, many hospitals are investigating methods to reduce fluoroquinolone use. Computerized prescriber order entry (CPOE) provides an opportunity to develop and implement clinically guided order sets that discourage the use of fluoroquinolones. To date, there are few studies investigating the effect of clinically guided order sets on medication utilization. This study aims to investigate the hypothesis that incorporating clinical guidance and leveraging antimicrobial stewardship into a CPOE diverticulitis order set would reduce fluoroquinolone use in the treatment of diverticulitis. Methods A diverticulitis order set was revised to provide guided antibiotic selection based on a patient’s penicillin allergy. Patients were split into two groups based on admission date relative to the implementation date of the revised order set. Fluoroquinolone use was compared between both groups. The primary outcome was the percentage of patients who were ordered a fluoroquinolone-containing regimen during their stay. The secondary outcome was the percentage of regimens that contained a fluoroquinolone. A subgroup analysis was conducted exclusively on patients whose antibiotics were ordered with the diverticulitis order set. Results 494 patients were included in the study. 316 patients in the pre-order set group, 178 patients in the post-order set group. 56% of patients in the pre-group received a fluoroquinolone in their regimen versus 46% of patients in the post-group (RR=0.82; 95% CI 0.68–0.99, p = 0.028). 49% of regimens in the control group contained a fluoroquinolone versus 39% of regimens in the experimental group (RR=0.78; 95% CI 0.64–0.95; p = 0.012). 77.5% of patients in the control subgroup received a fluoroquinolone in their regimen versus 42.4% of patients in the experimental subgroup (RR=0.55; 95% CI 0.36–0.84, p = 0.0062). Fluoroquinolone days of therapy decreased from 90.6 to 58.6 from 2018–2019. Clostridioides difficile infections also decreased during this time frame. Table 1: Average fluoroquinolone days of therapy per 1000 patient days Figure 1: Percentage of Diverticulitis Orders by Antibiotic Regimen: Pre- and Post-Order Set Change. CFP=cefepime, Metro=metronidazole, PIP-TZ=piperacillin-tazobactam, AM-SB=ampicillin-sulbactam, CIP=ciprofloxacin, Levo=levofloxacin, FQ=fluoroquinolone Figure 2: Fluoroquinolone days of therapy per 1000 patient days from 2016–2020. Conclusion Our findings support the hypothesis that incorporating clinical guidance into a CPOE order set would reduce fluoroquinolone use for the treatment of diverticulitis. Figure 3: Indicence of Clostridioides difficile infection per 1000 patient days Disclosures All Authors: No reported disclosures

Improving the Safety and Quality of Systemic Treatment Regimens in Computerized Prescriber Order Entry Systems

Purpose: Systemic treatment (ST) computerized prescriber order entry (CPOE) and preprinted orders (PPO) are proven to reduce errors. There is no known guidance in oncology to facilitate high-quality, accurate regimen development and review; hence, this was identified as a system-wide gap. This provincial initiative aimed to improve the quality of oncology regimens through a comprehensive review of systemic treatment (ST) regimens and the development of standards. Methods: A system-wide analysis of all active regimens (both CPOE and PPO) to ensure they were built as intended was conducted in 2015. Thirty-five hospitals (on behalf of 75 treatment facilities) were asked to report any unintentional discrepancies and details of the maintenance review process. Discrepancies were compiled, categorized, and analyzed for potential to cause harm. In addition, a multidisciplinary expert working group was formed to create best practice recommendations. Results: The review yielded a 94% response rate and took a total of 18 months to complete (70% completed within 9 months). The average number of regimens reviewed was 336 (range, 15 to 700; n = 9). Unintentional discrepancies were reported by nine hospitals (27%). A total of 369 discrepancies were reported (average, 55 per hospital), and 28 were deemed to have a moderate potential for harm. Only two hospitals (6%) had an established maintenance process; now, all have standard processes for review. Consensus-based recommendations for ST-CPOE and PPO regimen development and maintenance were developed. Conclusion: The review identified unintentional discrepancies and, because of the potential for patient harm, corrective action has been taken. Identified discrepancies have been amended, and standard regimen development and maintenance review processes are now implemented system-wide to improve the quality and safety of systemic treatment delivery.

Prevalence of Unrounded Medication Doses and Associated Factors Among Hospitalized Pediatric Patients

OBJECTIVES This study aims to determine the prevalence and factors associated with unrounded doses ordered via a computerized prescriber order entry (CPOE) system among children during a 1-week reference period. METHODS This retrospective, cross-sectional study included children younger than 18 years admitted during a 7-day period. An unrounded dose was defined as an unrounded actual dose (eg, dose calculated to the tenths place for non–neonatal intensive care (non-NICU) patients and dose calculated to the hundredth place for NICU patients) or unrounded volume per dose [eg, <0.1 mL for non-NICU patients and <0.01 mL for NICU patients]. A multilevel logistic regression model was used to determine the prevalence and factors associated with unrounded doses via a CPOE system with adjustment for clustering effects. RESULTS A total of 395 patients were admitted with 391 receiving medications. The overall prevalence of unrounded doses was 30% among the 2426 doses administered. Patients on the NICU team had the highest prevalence of unrounded doses. The odds of an unrounded dose were 4% (adjusted odds ratio, 0.96; 95% confidence interval, 0.94–0.98) lower with each additional kilogram increase in weight after controlling for age, route, scheduled versus as-needed administration, and cluster effects. CONCLUSIONS The prevalence of unrounded doses was higher than in previous studies. It was higher in smaller children after controlling for age, medication-related variables, and clustering. Future studies should focus on the role of CPOE in preventing unrounded and unmeasurable doses and if these strategies affect clinical outcomes (eg, adverse drug events).