Category: Federal Forum Posters
Purpose: The appropriate usage of fluoroquinolones has increasingly been an area of focus. Widespread usage has fueled higher resistance rates. In May 2016 the FDA recommended their use be restricted in uncomplicated infections based on an increasing awareness of rare but serious adverse reactions. The purpose of this quality improvement project was to assess how implementation of a forced electronic order set impacted outpatient fluoroquinolone prescription rates in a rural VA healthcare system.
Methods: In this retrospective analysis, outpatient oral fluoroquinolone prescription rates at a rural VA health system were analyzed prior to and after implementation of a mandatory electronic order set. Prior to initiation, prescribers could select a fluoroquinolone unrestricted from our outpatient medication list. After implementation, all oral fluoroquinolones were removed from this list and prescribers were required to use an order set which mandated documentation of patient education on fluoroquinolones.
Results: The order set was implemented June of 2014. Annual usage rates of oral outpatient fluoroquinolone prescriptions (Rx/1000 pts) from 2013 to 2018 declined steadily from 1,778 to 567 showing an overall reduction of 68%. Over the same period the average overall reduction in our regional VA network was 37%.
Conclusion: Implementing a mandated order set for outpatient oral fluoroquinolones requiring patient education was correlated with a significant reduction in prescription rates of oral outpatient fluoroquinolones in a rural VA healthcare system. This reduction significantly outpaced average regional peer group rates of decline. This intervention may be a useful tool to bolster antimicrobial stewardship and decrease the inappropriate usage of fluoroquinolones.