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Background Empiric therapy for possible late-onset sepsis (LOS) due to Gram-positive bacteria in the neonatal intensive care unit (NICU) has included vancomycin to cover, among other pathogens, coagulase-negative staphylococci (CoNS) which are the most frequent cause of bloodstream infections (BSI). In 2015, Nationwide Children's Hospital (NCH) neonatal antimicrobial stewardship (nASP) team recommended nafcillin rather than vancomycin, in combination with gentamicin, as the preferred agent for empiric therapy of LOS in infants not colonized with methicillin-resistant Staphylococcus aureus , irrespective of presence of a central venous catheter. The NCH nASP team provides oversight for 6 Columbus NICUs, and Our objective was to evaluate the impact of the vancomycin reduction program, with secondary objectives including duration of therapy, recurrence of BSI within 14 days of completion of therapy, and mortality. Methods The pharmacy database at NCH was queried with respect to all nafcillin and vancomycin use from 2013–2018. Pertinent clinical and laboratory data were obtained from the electronic health record (EHR) on all infants who had nafcillin or vancomycin therapy initiated, with each initiation defined as an antibiotic "course." Results From 1/2013 to December 2014 (pre-vancomycin reduction), there was an average of 112 vancomycin and 42 nafcillin courses provided to infants each year. From 1/2015 to December 2018, the use of nafcillin increased to an average of 90 courses while vancomycin decreased to 55 courses per year (P < 0.01). Since the institution of the vancomycin reduction program, preliminary EHR review of 50 infants has shown that 9 had a positive blood culture (7 CoNS; 2 methicillin-susceptible S. aureus ; 1 Escherichia coli). All CoNS isolates were resistant to nafcillin, and all infants sterilized the blood culture within 24 hours of vancomycin. The overall median length of therapy was 3 days with nafcillin or vancomycin. However, when excluding rule outs, the median duration of therapy was 9.5 days. There was no BSI recurrence or infection-related death. Conclusion An empiric antibiotic regimen that includes nafcillin rather than vancomycin for possible LOS in high-risk infants in the NICU effectively and safely reduced overall vancomycin use. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Purpose To describe the development and implementation of an electronic pharmacy scoring tool (PST) to prioritize patients requiring clinical pharmacy intervention and assist in workload management in a freestanding pediatric hospital using quality improvement methodology. Summary The department of pharmacy at Nationwide Children's Hospital developed a pediatric-specific PST within the electronic medical record to aid in patient prioritization and ensuring proficient daily workflow and qualifying workload for clinical pharmacists. The PST identifies patients for monitoring of high-risk medications, complex medication regimens, or abnormal laboratory values related to medication management. Application of the scoring tool ensures each patient is reviewed by clinical pharmacy staff each day, with initial efforts focused on patients with significant clinical pharmacy needs. This tool reduces the need for time-intensive manual chart review for identification of patients whose medication use and/or laboratory values afford greater opportunity for pharmacist intervention. Additionally, clinical pharmacist productivity metrics and workloads are considered, with the qualifying of patient care activities and quantification of time spent on patient review. Conclusion A PST enhances pediatric patient prioritization for clinical pharmacists by identifying patients most likely to require intervention in real time. The scoring tool enables future assessment of clinical pharmacists' workload assignments and better quantifies time spent on patient care activities. [ABSTRACT FROM AUTHOR]