570. What’s the Harm? Development and Implementation of an Antimicrobial Stewardship Intervention Impact Score

Abstract Background Various metrics evaluate antimicrobial stewardship program (ASP) success, including utilization, cost savings, and guideline adherence. Patient safety initiatives are at the forefront of hospital metrics. No commonly applied ASP measures evaluate patient harm. Our objective was to develop and implement a novel scoring tool quantifying the impact of ASP interventions on prevention of patient harm. Methods This initiative was conducted at a 386-bed pediatric hospital with an ASP conducting prospective audit with feedback (PAF) rounds since 2008. ASP created a multidisciplinary subgroup to develop a scoring tool classifying interventions as low, moderate, and high impact. With low impact interventions, patient harm was unlikely, but opportunities existed for minor antimicrobial optimization. Moderate interventions had substantial room for optimization but still had low risk for patient harm. High impact interventions carried a substantial risk of patient harm due to high probability of an adverse drug event or due to poor outcomes from an inappropriate regimen. Using these principles, definitions for each level of impact were created for all ASP intervention categories (Table 1). ASP providers were trained on the tool and scored each intervention on daily PAF rounds. To improve objectivity, 2 ASP providers independently scored each intervention and discrepancies identified. Discrepancies were evaluated monthly, and the tool was modified. Results Between 11/9/21-3/31/22, ASP reviewed 2010 antimicrobial orders with 238 interventions made and scored for impact. Of these, 124 (52.1%) were low, 99 (41.6%) moderate, and 15 (6.3%) high impact. There were 26 scoring discrepancies identified which were discussed by the ASP subgroup. To further clarify definitions, there were 5 substantive definition changes and 4 minor modifications; most changes were made in 12/2021. Conclusion We describe here the successful implementation of a novel tool to score ASP interventions on stewardship impact and prevention of patient harm. Future directions include utilizing this tool to direct systematic ASP interventions, partnering with organizational patient safety, and engaging in a multi-institutional working group for further development. Disclosures All Authors: No reported disclosures.