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Incorporating preauthorization into antimicrobial stewardship pharmacist workflow reduces Clostridioides difficile and gastrointestinal panel testing

Published online by Cambridge University Press:  03 June 2020

Nikki N. Tran
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
John P. Mills
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Christopher Zimmerman
Affiliation:
Departments of Health Information and Technology Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, Michigan
Tejal N. Gandhi
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Alison C. Tribble
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
Lindsay A. Petty
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Jerod Nagel
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Adamo Brancaccio
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Gianni Scappaticci
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Twisha Patel
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Nicholas O. Dillman
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Randolph Regal
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Kristin C. Klein
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Laraine Washer
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Vincent D. Marshall
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Jennifer Sweeney
Affiliation:
Department of Infection Control & Epidemiology, University of Michigan, Ann Arbor, Michigan
Krishna Rao
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Gregory A. Eschenauer
Affiliation:
Department of Pharmacy, University of Michigan, Ann Arbor, Michigan
Corresponding
E-mail address:

Abstract

Objective:

To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea.

Design:

Single center, quasi-experimental before-and-after study.

Setting:

Tertiary-care, academic medical center in Ann Arbor, Michigan.

Patients:

Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficile enzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours.

Intervention:

A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained.

Results:

An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56–0.93; P = .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37–0.77; P = .001), respectively.

Conclusions:

We identified an efficient, effective C. difficile and GIPAN diagnostic stewardship approval model.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

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