{'fraction_non_alphanumeric': 0.046471100784199824, 'fraction_numerical': 0.03528899215800174, 'mean_word_length': 4.8364406779661016, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 1, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Vancomycin Safety Monitoring Using an Electronic Health Record Database

Abstract Background Measures of antimicrobial safety are important for antimicrobial stewardship programs (ASP) and health-system quality. Vancomycin (VAN) is a frequently used antibiotic in the inpatient setting, and its most common serious adverse effect, acute kidney injury (AKI), can be identified reliably from laboratory data within the electronic health record (EHR). Our ASP reviews monthly AKI in VAN-treated patients, excluding prior kidney disease, as a metric for harm. EHR-derived rates of AKI were selected as a metric for health system quality and safety reporting. Methods IRB-exempt cross-sectional study using aggregate data in a 4-hospital health system. We used interrupted time series methods to compare AKI before and after implementation of a simplified vancomycin dosing strategy: pre- 11/15 to 4/16, post- 5/16 to 4/17. Primary endpoint: number of patients per month with AKI, defined as an increase in serum creatinine of at least 0.5 mg/dL or 50% of baseline. Denominator: number of vancomycin days of therapy (DOT) per 1000-patient-days. Rate of AKI in the total hospitalized population was used for context. Results There were 10453 orders for vancomycin across the study period (3634 pre, 6819 post). The average rate of AKI in patients receiving vancomycin was 10.6% pre, 8.9% post, while AKI rate in the total hospitalized population was 7.26% across the study period. After implementation of simplified VAN dosing policy, AKI per VAN DOT/1000 patient-days decreased from 0.46 to 0.40 (Figure 1). The median (IQR) vancomycin levels were: 16.7 μg/mL (16.2–17.1) pre, 15.8 (15.3–16.6) post. Conclusion EHR-based measures of antibiotic-related harm are promising tool for ASPs to measure impact patient outcomes. We observed reduced AKI in VAN treated patients, improving safety with a simplified VAN dosing strategy. Disclosures S. L. Davis, Allergan: Grant Investigator and Scientific Advisor, Consulting fee and Research grant; Merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant

Background. The bedside nurse is a frequently underutilized but potentially valuable contributor to antimicrobial stewardship. Minimal literature exists to demonstrate the impact of active intervention by bedside nurses in antimicrobial stewardship. We initiated bedside nurse-driven interdisciplinary rounds in a 31-bed inpatient telemetry unit of a community teaching hospital involving a pharmacist, infection preventionist and nurse practitioner. Rounds were focused on use of antibiotics, acid suppressants, urinary catheters and central venous catheters. Recommendations from rounds were communicated by the bedside nurse to the appropriate provider.
Methods. This was a prospective, observational pre-and post-intervention study (6 months in each cohort) to characterize the impact of bedside nurse-driven interdisciplinary rounds on use of antibiotics, acid suppressants, urinary catheters and central venous catheters in a telemetry unit.
Conclusion. Our data demonstrate that bedside nurses can contribute to antimicrobial stewardship and infection prevention outcomes when actively supported by a trained interdisciplinary team. Further study of strategies to engage bedside nurses in such activities is warranted.
Disclosures. All authors: No reported disclosures.

Vancomycin Safety Monitoring Using an Electronic Health Record Database
Michael P Veve, PharmD 1,2 ; Rachel M Kenney, PharmD 1 ; Jack Measures of antimicrobial safety are important for antimicrobial stewardship programs (ASP) and health-system quality. Vancomycin (VAN) is a frequently used antibiotic in the inpatient setting, and its most common serious adverse effect, acute kidney injury (AKI), can be identified reliably from laboratory data within the electronic health record (EHR). Our ASP reviews monthly AKI in VAN-treated patients, excluding prior kidney disease, as a metric for harm. EHR-derived rates of AKI were selected as a metric for health system quality and safety reporting.
Methods. IRB-exempt cross-sectional study using aggregate data in a 4-hospital health system. We used interrupted time series methods to compare AKI before and after implementation of a simplified vancomycin dosing strategy: pre-11/15 to 4/16, post-5/16 to 4/17. Primary endpoint: number of patients per month with AKI, defined as an increase in serum creatinine of at least 0.5 mg/dL or 50% of baseline. Denominator: number of vancomycin days of therapy (DOT) per 1000-patient-days. Rate of AKI in the total hospitalized population was used for context.
Results. There were 10453 orders for vancomycin across the study period (3634 pre, 6819 post). The average rate of AKI in patients receiving vancomycin was 10.6% pre, 8.9% post, while AKI rate in the total hospitalized population was 7.26% across the study period. After implementation of simplified VAN dosing policy, AKI per VAN DOT/1000 patient-days decreased from 0.46 to 0.40 (Figure 1). The median (IQR) vancomycin levels were: 16.7 μg/mL (16.2-17.1) pre, 15.8 (15.3-16.6) post.
Conclusion. EHR-based measures of antibiotic-related harm are promising tool for ASPs to measure impact patient outcomes. We observed reduced AKI in VAN treated patients, improving safety with a simplified VAN dosing strategy.  Background. An optional VAN loading dose (LD) of 25-30 mg/kg (total body weight), followed by maintenance dose (MD) of 15-20 mg/kg intravenously (IV) Q8-12H is recommended for patients with normal renal function. Studies suggest MO patients may require lower mg/kg doses to achieve therapeutic trough concentrations (TTCs). Our institutional VAN dosing protocol for MO patients (BMI ≥ 40 kg/ m 2 ) was revised in 2015 to recommend: LD 25-30 mg/kg (max 3000 mg), MD 12.5-15 mg/kg (max 2000 mg) IV Q8-12H. We evaluated initial TTC attainment, clinical and safety endpoints post protocol revision.

Efficacy and Safety of a Vancomycin (VAN) Dosing Protocol Developed for Morbidly Obese (MO) Patients
Methods. MO adult patients who received IV VAN between June 1, 2012-May 31, 2013 (pre-protocol revision) and August 1, 2015-July 31, 2016 (post-protocol revision) were included. Perioperative VAN, one-time doses, pregnancy, cystic fibrosis, hemodialysis and patients receiving VAN prior to admission were excluded.
Results. A total of 615 patients were screened, with 200 included for analysis (100 per group). Baseline demographics and VAN dosing are shown in Table 1. Initial TCs were drawn for 86 patients in the pre-revision group, and for 69 patients in the post-revision group. Initial VAN TCs are displayed in Table 2. Duration of VAN therapy was significantly shorter post-revision (5 days vs. 2 days, p ≤ 0.01). Mortality (14% vs. 10%, P = 0.38) and hospital length of stay (8.5 days vs. 7 days, p=0.09) were comparable