1021. Accuracy of Provider-Selected Antibiotic Indications at Point of Order Entry Compared with Electronic Health Record Documentation

Background The Centers for Medicaid and Medicare Services (CMS) state that hospital antimicrobial stewardship (AMS) policies require indications be documented for all orders. This may be included in the electronic medical record (EMR) or during order entry per CMS. Reliance solely on EMR documentation may be inconsistent or absent at times. In an effort to optimize compliance to this new measure and improve antibiotic use tracking, the University of Colorado AMS committee implemented required indications for all systemic antimicrobial orders. To follow up on this intervention we sought to determine the accuracy of ordered indication based on EMR documentation. Methods Retrospective review of antibiotics ordered between May 2, 2017 and December 1, 2017 among hospitalized patients aged 18–89 years. The primary objective was the accuracy of provider-selected indications (PSI) compared with EMR documented-clinical indication (DCI). Secondary objectives included accuracy comparison between check-box and free-text PSI format, and adherence to institutional antibiotic use guidelines. Differences between proportions of antibiotic orders with certain variables were assessed with Pearson’s chi-square and Fisher’s exact as appropriate. Results A total of 304 patients were evaluated with a median age of 56 years, 49% male, and 31% identified as immunocompromised. Check-box was most utilized in 81%, with 93% having a single indication selected. Most orders were classified as empiric (63%), followed by prophylaxis (23%) and definitive (15%). Frequent indications chosen were pneumonia (17%), bacteremia (13%), skin and soft tissue (10%), urinary tract infection (9%), and intra-abdominal infections (5%). Accuracy by PSI/DCI match was 78%, which was not different by a method of indication entry. Only indication type (P = 0.023) and care team specialty (P = 0.009) were shown to significantly impact accuracy. Nonadherence to institutional guidelines was 19%. Conclusion Antibiotic indications on order entry are an effective strategy to improve documentation and meet compliance around new CMS standards. Ordering by surgical services and prophylactic indications had lower PSI/DCI match, mostly resulting from absent EMR indication documentation. Disclosures All authors: No reported disclosures.