ID Corner: Antimicrobial Stewardship Initiative: Improvement of Health System Culture Result Review & Antibiotic Selection
by Sarah S. de Jesus, PharmD, Karlee A. Dulak, PharmD, Hannah F. Hansen, PharmD, BCPS, Jennifer R. Larson, PharmD, BCPS
Abstract:
Objective: The objective of this quality improvement project was to design and implement a pharmacist-led bacterial culture review and antibiotic selection program in the emergency department (ED) and walk-in-clinic (WIC) of a rural, critical access health system.
Methods: This project was completed in two phases: the pre-pharmacist implementation phase (phase I) and post-pharmacist implementation phase (phase II). During phase I, retrospective culture and chart reviews were completed to determine a baseline of inappropriate antibiotic prescribing in the ED and WIC. During phase II, pharmacists completed prospective audit and feedback on culture results to determine appropriateness of antimicrobial therapy. If the antibiotic was inappropriate, the pharmacist commented their recommendation on the culture result for providers to review and act upon. After three months of active culture review, a single pharmacist retrospectively reviewed pharmacist recommendations and documented if the intervention was accepted.
Results: A total of 1,236 retrospective and active chart reviews were assessed across phase I and II. There were 121 instances of inappropriate initial antimicrobial therapy in phase II, all of which were intervened on. Of the 121 interventions, 58 (47.9%) were acted upon by a provider, leading to a decrease in the number of patients with inappropriate antimicrobial therapy post-pharmacist intervention [119/638 (18.7%) vs 63/598 (10.5%)]. Instances of inappropriate antimicrobial practices assessed pre- and post- pharmacist intervention (respectively) included renal adjustment (4:1), antimicrobial spectra mismatch (7:1), incorrect dose (30:6), incorrect duration (79:53), and other interventions (7:2).
Conclusion: Pharmacist involvement in outpatient antimicrobial stewardship leads to improved antibiotic prescribing practices.
Keywords: Antimicrobial stewardship, antibiotic selection, bacterial culture, outpatient pharmacy, rural pharmacy
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2024 November/December Table of Contents
Abstract:
Objective: The objective of this quality improvement project was to design and implement a pharmacist-led bacterial culture review and antibiotic selection program in the emergency department (ED) and walk-in-clinic (WIC) of a rural, critical access health system.
Methods: This project was completed in two phases: the pre-pharmacist implementation phase (phase I) and post-pharmacist implementation phase (phase II). During phase I, retrospective culture and chart reviews were completed to determine a baseline of inappropriate antibiotic prescribing in the ED and WIC. During phase II, pharmacists completed prospective audit and feedback on culture results to determine appropriateness of antimicrobial therapy. If the antibiotic was inappropriate, the pharmacist commented their recommendation on the culture result for providers to review and act upon. After three months of active culture review, a single pharmacist retrospectively reviewed pharmacist recommendations and documented if the intervention was accepted.
Results: A total of 1,236 retrospective and active chart reviews were assessed across phase I and II. There were 121 instances of inappropriate initial antimicrobial therapy in phase II, all of which were intervened on. Of the 121 interventions, 58 (47.9%) were acted upon by a provider, leading to a decrease in the number of patients with inappropriate antimicrobial therapy post-pharmacist intervention [119/638 (18.7%) vs 63/598 (10.5%)]. Instances of inappropriate antimicrobial practices assessed pre- and post- pharmacist intervention (respectively) included renal adjustment (4:1), antimicrobial spectra mismatch (7:1), incorrect dose (30:6), incorrect duration (79:53), and other interventions (7:2).
Conclusion: Pharmacist involvement in outpatient antimicrobial stewardship leads to improved antibiotic prescribing practices.
Keywords: Antimicrobial stewardship, antibiotic selection, bacterial culture, outpatient pharmacy, rural pharmacy
Download PDF
2024 November/December Table of Contents