Choosing Wisely: Improving Fluoroquinolone Utilization at an Academic Medical Center Through Antimicrobial Restriction

Reduction in the use of fluoroquinolones is an important intervention for antimicrobial stewardship programs to minimize untoward effects of these agents (increased risk of neuropathies, dysglycemia among diabetics, QTc prolongation, acute kidney injury - risk if on concomitant ACE-Is or ARBs), association with C. diffinfection, increasing FQ gram-negative resistance). The antimicrobial stewardship program at the adult hospital changed the restriction status of FQs to require prior authorization before initiation of therapy to ensure safe and judicious prescribing of these agents. In addition to requiring PA, widespread educational efforts were implemented by ASP to provide guidance on when FQ therapy is appropriate and provide notification of upcoming restriction processes. Information technology was also utilized to aid in restriction efforts by requiring physicians to provide an indication with the order for the FQ in their computerized order-entry system, and an automatic stop date (5 days duration of therapy) was also applied for levofloxacin orders entered for community-acquired pneumonia.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)