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Stephanie Gore, PharmD PGY1 Pharmacy Practice Resident VCU Health System

Characterizing the change between intravenous piggyback and intravenous push antibiotic administration in the emergency department. Stephanie Gore, PharmD PGY1 Pharmacy Practice Resident VCU Health System. Disclosure.

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Stephanie Gore, PharmD PGY1 Pharmacy Practice Resident VCU Health System

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  1. Characterizing the change between intravenous piggyback and intravenous push antibiotic administration in the emergency department • Stephanie Gore, PharmD • PGY1 Pharmacy Practice Resident • VCU Health System

  2. Disclosure The authors and contributors of this project have no conflicts of interest to disclose

  3. Current Literature Kumar et al. 2006. Crit Care Med. 34 (6):1589-1596. Gaieski et al. 2010. Crit Care Med. 38 (4):1045-1053. Ferrer et al. 2014. Crit Care Med. 42 (8): 1749-1755.

  4. Antibiotic Timing Kumar et al. 2006. Crit Care Med. 34 (6):1589-1596. Gaieski et al. 2010. Crit Care Med. 38 (4):1045-1053. Ferrer et al. 2014. Crit Care Med. 42 (8): 1749-1755. Rhodes A, et al. 2017.Crit Care Med.45(3):486-552

  5. Drug Shortage • September 2017 • Hurricane Maria devastated Puerto Rico • Pharmaceutical products made in Puerto Rico account for about 10% of all drugs consumed in United States • November 2017 • Critical antibiotic shortages force VCUHS to change from IVPB to IVP antibiotics • Cefazolin • Cefepime • Ceftriaxone IVPB: intravenous piggyback IVP: intravenous push https://www.fda.gov/downloads/newsevents/newsroom/fdainbrief/ucm584030.pdf

  6. ED medication distribution Intravenous Piggyback vs Intravenous Push IVP cefepime 2018 Administration: 3-5 mins IVPB cefepime 2017 Administration: 30-60 mins Materials: IV tubing Alaris™ pump Materials: 10 mL syringe 18 gauge needle 10 mL NaCl 0.9% Is there a difference between IVPB and IVP cefepime administration? IV: Intravenous ED: Emergency department Images retrieved from: http://products.fresenius-kabi.us/product-184.html https://www.bbraunusa.com/en/products/b0/2g-cefepime-for-injectionuspanddextroseinjectionusp.html https://www.allivet.com/p-2997-18g-x-1-inch-needle https://www.amazon.com/BD-302995-Box-Syringe-Only-Luer-Lok https://www.aaawholesalecompany.com/hos-488820-pk.html

  7. Outcomes Time from order to administration of first empiric antibiotic • Time from order to administration of second empiric antibiotic (if applicable) • Duration of treatment • Mortality • Direct cost differences Newly documented adverse event

  8. Methods • Approved by VCU Institutional Review Board • Retrospective, observational cohort study • IVPB: January 2017 through June 2017 • IVP: January 2018 through June 2018 • Data collected from Cerner Information Systems • Quality improvement project • To help determine if the switch to IVP antibiotics should be continued once medication shortages resolve

  9. Statistical Analysis • IBM SPSS Statistics 25 • Baseline characteristics: Descriptive statistics • Continuous variables: Mann-Whitney U test • Categorical variables: Chi-Square

  10. Patient Population

  11. Charts assessed for eligibility (n=499) Excluded: prisoners (n=17) Patient Flow Diagram Eligible patients (n=482) IVPB cefepime 2017 reviewed (n=165) IVP cefepime 2018 reviewed (n=317) IVPB cefepime 2017 included in analysis (N=159) IVP cefepime 2018 included in analysis (N=304) Excluded: not received in the ED (n=6) Excluded: not received in the ED (n=13)

  12. Patient Demographics Std dev: Standard deviation

  13. Patient Demographics

  14. Primary and Secondary Outcomes Mins: Minutes IQR: Interquartile range

  15. Characteristics of Adverse Events

  16. Direct Cost Savings * Includes price for primary set infusion tubing **Includes price for 10mL syringe, 18G needle, 10 mL NaCl 0.9% vial NaCl = Sodium chloride Pricing retrieved from: https://www.meadowsmedical.com/online-store/iv-pharmacy/iv-tubing/alaris-71-72-series-primary-set-detail http://shop.gohcl.com/default.aspx?page=item%20detail&itemcode=19837

  17. Limitations • Retrospective study • Single institution • Limited time period • Documentation bias • Restriction of meropenem

  18. Conclusion IVPB: intravenous piggyback IVP: intravenous push

  19. Future Directions

  20. Acknowledgements • Tammy Nguyen, PharmD, BCPS • Stephen Miller, DO

  21. Characterizing the change between intravenous piggyback and intravenous push antibiotic administration in the emergency department • Stephanie Gore, PharmD • PGY1 Pharmacy Practice Resident • VCU Health System

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