189. Evaluating the Impact of Mandatory Indications on Antibiotic Utilization: A Retrospective Study
Bibliographic record
Abstract
Mandatory indications for antimicrobial agents are recommended by a number of organizations to act as a force function, requiring prescribers to provide a reason for prescribing at the time of order entry. We evaluated the impact of introducing a mandatory indication field into electronic order entry for selected antibiotics on utilization of antibiotics at a large community hospital in the context of an established antimicrobial stewardship program. A descriptive analysis of the mandatory indication fields for the study antibiotics (intravenous and enteral clindamycin, ciprofloxacin, metronidazole, moxifloxacin, and vancomycin) for adult patients 18 years and above for 1-year (December 1, 2015–November 30, 2016) postimplementation was conducted. An independent t-test was used to measure the primary outcome of change in drug utilization of study and control antibiotics before (6 months pre) and after (12 months post) the initiation of mandatory indications. Drug utilization was calculated as days of therapy (DOT)/1,000 patient-days for both the study and control antibiotics individually and as a group. Oral amoxicillin/clavulanate and intravenous piperacillin/tazobactam orders which have no mandatory indications were used to examine any associated shifts in antibiotic utilization. A total of 8,399 orders were evaluated in the 1-year post-implementation period; of which, 4,572 were for study antibiotics. The preset mandatory indications were selected 30–55% of the time. For the primary outcome, there was a statistically significant decrease in DOT/1,000 patient-days for study antibiotics as a group pre- and postintervention (mean 100 vs. 82, P = 0.024) as but not individually. However, there was a statistically significant increase in DOT/1,000 patient-days for the control antibiotics (mean 78 vs. 91, P = 0.01), driven by the increase in piperacillin/tazobactam utilization. This study showed the moderate use of preset mandatory indications which suggests that the preset list of indications can be optimized. Furthermore, mandatory indications were shown to be associated with a reduction in study antibiotics utilization but may lead to shifts in usage to other nonstudy antibiotics. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".