2092. Acceptability and Effectiveness of Implementation Strategies on Fluoroquinolone (FQ) Prescribing

Abstract Background The Food and Drug Administration (FDA) has issued multiple FQ safety warnings and recommends prescribing FQ only where alternatives are not available. We sought to assess the effectiveness and acceptability of differing implementation strategies on inpatient FQ prescribing. Methods Antimicrobial stewardship champions at 15 PBRN sites completed a survey in April 2018 regarding local use and acceptability of differing strategies to improve FQ prescribing. Sites with audit and feedback (PAF) and/or prior approval (PA) were compared with sites without these strategies. Antibiotic days of therapy (DOT) per 1000 days-present (DP) were extracted from the VA Corporate Data Warehouse for 2017–2018. Independent t-tests, contingency tables and simple linear regression were applied. Results 60% of sites had PAF or PA implemented for FQ. When compared with sites with no strategies in place (64.2 ± 34.4 DOT/DP), mean FQ prescribing rates were lower for sites that employed PAF/PA (35.5 ± 9.8; P = 0.03) and decreased over the 2-year period (P < 0.001 for trend by month). This decrease occurred without an increase in third/fourth-generation cephalosporins for the PAF/PA group (83.5 ± 18.8; P = 0.1 for trend), but increased for sites with no strategies in place (93.6 ± 55.2; P < 0.01 for trend). However, total antibiotic prescribing rates were not different for sites with PAF/PA (561.7 ± 77.8) or without strategies (644.1 ± 157.7; P = 0.2) and did not change over time (p> 0.2). Sites with PAF/PA that reported FQ implementation strategies were “completely” accepted had lower FQ rates than where it was moderately accepted (34.2 ± 5.7 vs. 48.7 ± 4.5; P < 0.01). The PBRN sites perceived that clinical pathways/local guidelines (93% of 15 sites), PA (93%), and order forms (80%) “would” or “may” be effective in improving FQ use. While most sites (73%) indicated that requiring infectious disease consults “would” or “may” be effective in improving FQ use, 87% perceived implementation to be difficult. Conclusion PAF and PA implementation strategies focused on FQ were associated with lower FQ prescribing rates, but not overall antibiotic use, indicating class substitution. This may indicate increased acceptability of implementation strategies and/or sensitivity to the FDA warnings. Disclosures All authors: No reported disclosures.