Implementing a simplified targeted feedback method to reduce fluoroquinolone prescriptions in emergency departments

Minh Le, PharmD Alyssa Christensen, PharmD, BCIDP, Brent Footer, PharmD, BCPS Providence Health System, Oregon Implementing a simplified targeted feedback method to reduce fluoroquinolone prescriptions in emergency departments Background: The CDC has proclaimed antibiotic resistance to be one of the biggest public health challenges of our time. Although fluoroquinolones (FQs) are among the most widely prescribed antibiotics in the ambulatory setting, there have been recent efforts to reduce their usage due to mounting concerns regarding their safety profile and resistance patterns. Provider audit-and-feedback has been shown to be among the most effective antimicrobial stewardship interventions, but the auditing process requires significant healthcare resources, is time consuming, and must be continuous in order to have sustained durability. The purpose of this study is to determine if targeted provider feedback and education material can reduce FQ prescriptions independent of prospective auditing and feedback. Methods: This is an ongoing, multicenter, quasi experimental study across all emergency departments of a large healthcare system within the Oregon region. The primary objective is to decrease overall FQ prescriptions. Secondary objectives include reduction of FQ prescriptions by individual prescriber and study site. Pre-intervention antibiotic data was gathered between October and December 2019. Aggregate FQ prescription data was extrapolated by individual prescriber and study site and distributed in January. Education material containing the latest guideline recommendations and relevant practice pearls was also provided. Post-intervention data was then gathered between February and March 15. This study has been approved and given exempt status by the institutional review board. Results: There was a total decrease in both FQ and all antibiotic prescriptions in the post-intervention period. Total encounters in which a FQ was prescribed was significantly lower in the post-intervention period with a difference of 2 (95% CI 1.6 to 2.3; p 1 FQ prescriptions) for each provider, there was a statistically significant reduction in FQ rates from 140 providers (78.2%) in the pre-intervention period to 66 (39.3%) in the post-intervention period (p-value=0.0084). There was not enough data to perform statistics on FQ rates per provider or between study sites. Conclusion: Targeted provider feedback led to an overall decrease in FQ prescriptions. Although the preliminary results are encouraging, more data is needed to detect the true impact of the intervention and analyze trends.https://digitalcommons.providence.org/pharmacy_PGY1/1014/thumbnail.jp