1. Analyzing the Use of Antimicrobials Using Provider Selected Indications
Haley Obermeier, Sarah Parker, MD, Jason Child, PharmD, Kelly Pearce, Research Analyst

2. Indications in General
Approximately 70% of patients admitted into studied area got one or more doses of anti-infectives
They are commonly known as Provider Selected Order Indications (PSOI)
Allows pharmacists to do immediate review of dosing appropriateness
Occurs within 24 hours of order
Increases the quality of care

3. Background
The Antimicrobial Stewardship Program (ASP) implemented widespread requirement in 2016
Beginning In 2013, only 14 Antimicrobials required Provider Selected Order Indications (PSOI) (ASP)
Clinical indications are required by Centers for Medicare and Medicaid Services & Joint Commission
PSOI demonstrated to be effective by “Evaluation of Provider Selected Order Indications on Appropriateness of Antimicrobial Orders”
Yoski Nomura

4. Purpose A descriptive study to…
To analyze the use of antimicrobials within the hospital in 2016
To analyze the indications and their most commonly selected antimicrobials
Process improvement using the written in comments
Process improvement to add antimicrobials not included

5. Example of PSOI

6. Methods Extracted from ID Universe
Pulled all routes & Analyzed by routes
Antibiotics, antifungals, antivirals, antiparasitics (all anti-infectives)
Solely administration and inpatient data
Analyzed the most commonly written in Indications

7. Excluding Data An original 57,710 orders were pulled
Includes all anti-microbial orders from 2016
11,394 orders that had no indication at all excluded
46,316 Remain
These were blank for various reasons
1,896 excluded that only had an indication comment
44,420 Remain to be analyzed
These orders all have an indication, some also have a comment written in
7,252 Orders with Prophylaxis- Medical/ Surgical Separated
Sheer amount of these orders muddled data
Made up a significant amount of the data
37,168 Orders remain to be compared

9. AMOXICILLIN-PO
5157
100%
OTITIS MEDIA
2856
55%
PNEUMONIA/SINUSITIS
1364
27%
PHARYNGITIS
764
15%
URINARY TRACT INFECTION
104 2%
SKIN/SOFT TISSUE INFECTION 61 1%
MUSCULOSKELETAL INFECTION 8
<1%

10. AMOXICILLIN
asplenia 10
Not on
dental 16
Pneumonia
Present
prophylaxis 17
oral drug challenge 27
Not On
tracheitis 29

12. SEPSIS/BACTEREMIA - SUSPECTED/CONFIRMED
6462
100%
VANCOMYCIN-IVSOLN
1675
28%
CEFTRIAXONE
1089
18%
AMPICILLIN
1034
17%
CEFOTAXIME
557 9%
GENTAMICIN
459 8%
CEFEPIME
415 7%
MEROPENEM
269 5%
CEFTAZIDIME
192 3%
METRONIDAZOLE
151
CLINDAMYCIN
146 2%

13. Limitations Only 12 Indications available
Could not count any of the written in indications
Some locations don’t have indications
Some drugs don’t have indications
Widespread Indications have only been used since the beginning of 2016

14. Future Direction Altering Indications Medical/Surgical Prophylaxis
Using Free Text Comments to get more information
Adding missed medications
Removing unused indications

15. Acknowledgments
Thank you to Amanda Hurst, PharmD, the CHCO pharmacy, and the entire ASP team