1. A pilot assessment of the impact and resource implications of a 48-hour ward-based stewardship team review on antibiotic use in a tertiary centre Nicola Fawcett 1,2,3, Nicola Jones 1, 1 Oxford University Hospitals NHS Trust, Oxford, UK, 2 Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK Introduction Antibiotic resistance is a major threat to global public health. Effective methods of safely reducing antibiotic use are required. A 48-hour antibiotic prescription review is recommended by a Department of Health campaign (Start Smart - then Focus) to minimise antibiotic use in hospital admissions. Local audits have previously showed that 48-hour reviews were being carried out in 70-80% of cases, but the decision was to continue the course of therapy in the majority of cases. Implementation of telephone 48hr advice in other sites have had mixed results. We conducted a pilot study to assess whether a ward/ patient-based 48hr review by an Infectious Diseases Acute Physician (IDAP) might be a feasible intervention to improve antibiotic use. Method Ward-based reviews were carried out by a Stewardship team (IDAP and Research Fellow/Nurse) of patients on antibiotics for >48hrs in a teaching hospital (Oxford University Hospitals). In all cases the team decision was to continue antibiotic therapy. Cases were examined and their records and results reviewed. The recommended decision was recorded according to the “Start Smart - then Focus” classification. Hospital databases were reviewed to assess number of admissions in the trust. Results 60 patients were reviewed (44 under Medicine (AGM), 11 under surgical specialties (SS). A change in antibiotic prescription was recommended in 35 (41%), and antibiotics stopped in 14 (23%). A structured systematic review took 10-15 minutes. Median number of emergency admissions to medicine and surgery per day was120 (mean 118) of which an average of 33% (40) were started on an antibiotic. At 48hrs estimated numbers still an inpatient on antibiotics was 15-20. Discussion This pilot study suggests that the implementation of a ward-based review service would have a significant impact on inpatient antibiotic use To review every patient on antibiotics at 48hrs, a conservative estimate of resource implications was 5 hours of a stewardship team per day Approximately half of all patients started on antibiotics were discharge prior to a 48 hour review The review process served to identify targets for stewardship initiatives, including guidelines changes aimed at reducing use of one agent (co-amoxiclav), and educational initiatives aimed at supporting team decision making towards stopping or narrowing antibiotic spectrum. Conclusion This pilot study suggests that 48hr stewardship review of cases has a large impact on antibiotic use, but has significant resource and workload implications. A larger study is required to further assess the impact and cost-effectiveness of this approach Initiatives which would impact on antibiotic use for patients discharged before 48hrs should also be considered in reducing antibiotic use Ward based reviews can also serve to inform targeted stewardship initiatives References: 1.Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associate Infection (ARHAI) : Start Smart- Then Focus Guidelines 2.Evaluation of Postprescription Review and Feedback as a Method of Promoting Rational Antimicrobial Use: A Multicenter Intervention -Cosgrove et al 2012 19 Nicola.fawcett@ ouh.nhs.uk 01865 222194