Jennifer Cole, BCCCP, BCPS, PharmD
Critical Care Pharmacy Specialist
Veterans Health Care System of the Ozarks
Fayetteville, Arkansas
Disclosure information not submitted.
Sarah Smith, PharmD
PGY-1 Pharmacy Resident
VHSO, United States
Disclosure information not submitted.
Title: Effects of a novel steroid stewardship project in hospitalized AECOPD patients
Introduction: Steroid overprescribing is well documented in AECOPD and may lead to adverse effects. This study tested the effects of a 3-part stewardship intervention on mean prednisone equivalents prescribed in hospitalized patients.
Methods: Interventions consisted of 1) an anonymous survey for prescribers involving a simplified AECOPD case, 2) education and peer-comparison with survey results, and 3) prospective audit and feedback. This before and after study utilized two 12-month time periods with a 6-week washout period for comparison (before cohort April 2019-March 2020, after cohort May 2020-April 2021). The primary outcome was prescribed inpatient daily prednisone equivalents. Secondary outcomes included total steroid duration, length of stay (LOS), 30-day readmissions, and hyperglycemia (defined as any serum glucose reading >180mg/dL). Patients had to be admitted at least 24 hours and given systemic steroids for inclusion. Exclusion criteria included structural lung disease, AECOPD within 30 days prior to admission, and steroid use for indications other than AECOPD. An 80% power analysis revealed 27 patients in each group were needed to detect a 50% reduction in mean steroid doses. Continuous data were analyzed with a students T test (or Mann Whitney U) and nominal data were compared with a chi square test (or Fisher's Exact) in R studio.
Results: Mean daily prednisone equivalents were significantly lower in the after group (total 118mg vs 53mg, p=.0003) in both ICU (160mg vs 61mg, p=.008) and non-ICU locations (102mg vs 49mg, p=.004). Total durations were similar (median 8d vs 7d, p=0.44), LOS was similar (mean 3.3d vs 3.9d, p=0.21), as were 30-day readmissions (15% vs 7%, p=0.39) and incidence of hyperglycemia (48% vs 44%, p=0.78).
Conclusion: Reported is the first multi-faceted steroid stewardship intervention which significantly reduced steroid dosing in hospitalized AECOPD patients without known deleterious effects.