Antibiotic prescriptions upon hospital discharge: A blind spot of antimicrobial stewardship

Background: Transitions of care are a known source of patient vulnerability. The incidence of medication errors during transitions of care is well-documented.1 Discharge from the hospital has proven to be one area where antimicrobial stewardship is absent or lacking and can result in: poor clinical outcomes, adverse drug events, and emergence of multidrug resistant organisms. In one study, 53% of cases reviewed found antibiotics prescribed at discharge were inappropriate.1 Large discrepancies exist between guideline recommendations and antimicrobials prescribed upon hospital discharge.2 At this time, no prior study at OSU Medical Center has analyzed the impact of antimicrobial stewardship at hospital discharge.Methods: This study will be a retrospective chart review based on a report of patients age 18 years and older discharged from OSUMC from 7/1/2018 to 6/30/2019 with CAP or uncomplicated UTI. This data will be used to determine whether optimal antibiotic therapy was prescribed upon hospital discharge. Optimal therapy is defined as: prescription in accordance with nationally-approved guidelines for the management of CAP and UTI; effective and narrowest spectrum of activity; correct dose for indication, organ dysfunction, and medication allergies; and correct duration of therapy. This study will also the assess antibiotic classes most frequently involved in errors, as well as the most commonly occurring types of errors (incorrect drug, dose, or duration). Patients with multiple types of infection will be excluded from the study. Data collected will be organized and evaluated using REDCapTM. The following data will be obtained: date of discharge, days of optimal inpatient antibiotic therapy, discharge antibiotics regimen, infection type (CAP vs. uncomplicated UTI), pertinent laboratory and microbiology data, and bacteria cultured with source and date results finalized.Results: Data collection is still ongoing. At this time, 1402 patient charts have been reviewed, and 168 patient charts met inclusion criteria. Of those included, patients were primarily female (63%) with an average age of 62 (range 21-95), and 43% were discharged on a suboptimal antibiotic regimen. The most common reason for a suboptimal regimen was an inappropriate duration of therapy (92%) followed by an incorrect medication dose (26%).Conclusions: At the time of this writing, duration of therapy far outweighs any other cause for a suboptimal discharge antibiotic regimen. By completing this study, we hope to gain more insight into how we can better serve our institution by educating physicians, reducing errors, and optimizing transitions of care