247. Sustaining Excellence of Care During a Fluid Shortage: Snapshot of Antibiotic Mitigation Strategies Following Hurricane Maria

Abstract

BackgroundIntravenous (IV) antibiotics (ABX) are standard for treatment of many inpatient infections. A devastating Puerto Rico hurricane in September 2017 resulted in critical shortages of IV ABX and fluids. In response, a comprehensive review of viable mitigation strategies related to antimicrobials was coordinated at our center to ensure continued excellence in care was provided to all patients.MethodsA multidisciplinary mitigation task force (MTF) was established to begin immediate fluid conservation efforts from an antimicrobial perspective.ResultsFirst, ABX regimens were converted to oral equivalents where clinically appropriate. Second, the ABX stewardship team (ASP) offered alternatives to IV ABX that required a large volume of fluid for reconstitution (e.g., ampicillin-sulbactam (A/S, 400 mL fluid/day), meropenem (MER, 300 mL fluid/day). Third, through prospective audit and feedback (PAF), we transitioned patients from A/S (n = 37), cefazolin (n = 21), and IV doxycycline (n = 4) to either oral or alternative IV therapies. We completed additional PAF transitions of IV metronidazole (n = 15) and MER (n = 7). Lastly, 24 ABX products were transitioned to alternative routes of delivery or to diluent fluids. Products were transitioned from mini bags to IV push (n = 10) and IV syringe pump (n = 10). Each product transition required coordinated efforts from over 10 teams including electronic ordering. Education consisted of 20 newsletters created for nursing and 10 order verification packets created for pharmacists. Metrics were established to ensure sustained impact through bi-weekly ABX scorecards. After 6 days of IV metronidazole ASP restriction, use decreased 52% from baseline. With the transitions in place, an average of approximately 100 liters of fluid was conserved per week.ConclusionThe immediate and collective response of the MTF allowed for the continued capability to provide IV ABX for patient care as supplies fluctuated. Continued education supported safe transitions. Further data will determine the impact of the fluid shortage on patient outcomes once critical supply levels have resolved. These efforts establish a foundation for ongoing initiatives after shortages are resolved.Disclosures M. H. Nguyen, Merck: Grant Investigator, Research grantAstellas: Grant Investigator, Research grant