Original Research
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction:
Fluoroquinolones are frequently used due to their favorable administration frequency, high bioavailability, and broad spectrum of activity. However, fluoroquinolones are associated with numerous serious adverse events including tendinitis and Clostridioides difficile infection. To optimize fluoroquinolone prescribing, our facility implemented an outpatient order set.
Research Question or Hypothesis:
We hypothesize a decrease in outpatient fluoroquinolone prescriptions may be observed after implementation of an order set.
Study Design: Retrospective, quasi-experimental analysis
Methods:
We conducted an analysis of patients prescribed oral fluoroquinolones three months before and three months after implementation of an outpatient fluoroquinolone order set on August 15th, 2022. Outpatient fluoroquinolone ordering was restricted to the evidence-based order set. The primary outcome of this study is frequency of fluoroquinolone prescribing. The secondary efficacy outcomes are average day supply of fluoroquinolones and rate of inappropriate fluoroquinolone prescribing. The safety endpoints analyzed include recurrence of infection indicated by use of antibiotics within thirty days for same indication and fluoroquinolone-related adverse events.
Results:
Frequency of fluoroquinolone prescribing decreased by 27.45% after order set implementation, with 255 prescriptions in the pre-intervention cohort and 185 prescriptions in the post-intervention cohort. Inappropriate fluoroquinolone prescribing decreased by 38.52%. Kappa inter-rater reliability score between chart reviewers for inappropriateness was 0.73. Average day supply remained unchanged between groups.
Recurrence of infection was similar between pre-intervention and post-intervention groups. Incidence of abdominal aortic aneurysm or aortic dissection, tendinitis, and C. difficile infection remained similar between both cohorts (<1% for each cohort).
Conclusion:
Frequency and inappropriateness of prescribing of this antibiotic class decreased at our Veterans Affairs healthcare system following implementation of the outpatient fluoroquinolone order set. A high kappa inter-rater reliability amongst chart reviewers supports consistency of determining the secondary outcome of inappropriate prescribing.
Implementation of the outpatient fluoroquinolone order set did not lead to a clinically significant change in recurrence of infection or incidence of major fluoroquinolone adverse effects.
Presenting Author
Lauren Blumenfeld PharmDVA Tennessee Valley Healthcare System
Authors
Parmida Parvaz PharmD
VA Tennessee Valley Healthcare System
Ashleigh Powers PharmD
VA Tennessee Valley Healthcare System
Jessica Wallace PharmD, BCPS
VA Tennessee Valley Healthcare System
Rebekah Wooten PharmD
VA Tennessee Valley Healthcare System