To the Editor-The Centers for Disease Control and Prevention estimated that in 2018, emergency departments (EDs) generated 12.7 million antibiotic prescriptions. 1 Up to 50% of these prescriptions may have been inappropriate with respect to antibiotic use or selection, dosing, and duration, based on outpatient prescribing estimates. 2 Improving prescribing is imperative, but historically, EDs are underrepresented in antibiotic stewardship studies. 4 EDs may benefit from implementation of the recommended components of an antimicrobial stewardship program, including decision-making tools based on facility-specific practice guidelines. 3 For example, antibiotic order sets within an electronic medical record (EMR) have been shown to improve adherence to evidence-based prescribing for single diagnoses, 5,6 although the use of multiple order sets for a variety of diagnoses has not been well studied. We implemented EMR order sets for common infectious diagnoses in the ED, compared the prescribing practices of providers who utilized them to those who did not, and surveyed providers for barriers to use.
Background While the available SARS-CoV2 vaccines are up to 94% effective at preventing COVID-19-related death or invasive mechanical ventilation, only 76% of the United States population aged ≥18 years have received a primary series and 49% have received a booster. Vaccine administration has been complicated by changing schedule recommendations, packaging in multi-dose vials, and federal reporting requirements that may have limited the locations offering vaccines. We therefore implemented a pharmacy-based initiative to provide SARS-CoV2 vaccination to patients admitted to an academic health center, in order to encourage vaccination when patients had presented for other care. Methods A pharmacy committee developed a protocol for administering the three authorized SARS-CoV2 vaccines to interested inpatients while minimizing vaccine waste, monitoring for safety events, and providing next dose education. Associated training included multidisciplinary education on requirements related to vaccine Emergency Use Authorization (EUA) status. While developing the protocol, the vaccine committee utilized a temporary procedure to administer vaccines once weekly through review by antimicrobial stewardship pharmacists during August 2021. The protocol went live in September 2021 for inpatient and emergency department sites, with subsequent tracking of the number of doses ordered (stratified by vaccine type and dose number) and number administered. Results From August 3 2021 to March 25 2022, a total of 389 vaccine orders were placed with 302 doses (78%) administered, including 126 Moderna (48 first, 20 second, 15 third, 42 booster, and 1 undesignated), 165 Pfizer/BioNTech (80 first, 24 second, 41 third, 14 booster, and 6 undesignated), and 11 Janssen COVID-19 vaccine doses. Only 18 vaccine orders were placed on patients in the ED, with 14 (78%) of those doses administered. Of the 87 vaccine orders not administered, 6 were placed but not given, and 81 were placed and then discontinued. Conclusion With multidisciplinary collaboration, SARS-CoV2 vaccination can be performed in inpatient and ED settings. However, orders should be monitored for protocol compliance and order discontinuation, as these may increase potential for waste. Disclosures All Authors: No reported disclosures.
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