Pharmacist addition to the post-ED visit review of discharge antimicrobial regimens - 04/10/14
Abstract |
Objective |
Our objective was to evaluate whether pharmacist addition to the postvisit review of discharged adult emergency department (ED) visits' prescriptions/cultures would reduce the prevalence of revised antimicrobial regimen inappropriateness.
Methods |
We conducted a retrospective observational study of discharged adult ED visits to a single center with positive cultures requiring antimicrobial regimen revision (May 1 to October 31, 2012, nurse process; February 1 to July 31, 2013, nurse/pharmacist process). Investigators abstracted cohorts' medical records for demographic, ED diagnosis, original/revised antibiotic regimen, culture result, medical history, medications, and patient instruction data and determined whether the revised regimen was inappropriate based on Infectious Diseases Society of America/Centers for Disease Control and Prevention and clinical guidelines. We used the large sample z-test to compare the prevalence of revised antimicrobial regimen inappropriateness between the 2 cohorts.
Results |
In the prepharmacist cohort, there were 411 positive ED discharge cultures. Seventy-three (17.8%; 95% confidence interval [CI], 14.1%-21.5%) required antimicrobial regimen revision; 34 of these met 1 or more level of inappropriateness (46.6%; 95% CI, 35.1%-58.0%). In the postpharmacist cohort, there were 459 positive ED discharge cultures. Seventy-five (16.3%; 95% CI, 13.0%-19.7%) required revision; 11 of these met 1 or more level of inappropriateness (14.7%; 95% CI, 6.7%-22.7%; z = 4.2; P < .0001 for comparison).
Conclusion |
In this single-center study, pharmacist addition to the postvisit review of discharged adult ED patients' prescriptions/cultures reduced the prevalence of revised antimicrobial regimen inappropriateness.
Le texte complet de cet article est disponible en PDF.Highlights |
• | We evaluate pharmacist addition to post-ED visit antimicrobial regimen reviews. |
• | We compared to nurse-driven post-ED visit antimicrobial regimen reviews. |
• | We evaluated revised regimen appropriateness using published/clinical guidelines. |
• | The nurse-driven review process had 46.6% revised regimens that were inappropriate. |
• | Pharmacist addition reduced revised regimen inappropriateness to 14.7%. |
Plan
☆ | Presentation: This study was presented in abstract form at the Society for Academic Emergency Medicine Annual Meeting, Dallas, TX, May 15, 2014. |
☆☆ | Grant support: None. |
★ | Conflicts of interest: None. |
Vol 32 - N° 10
P. 1270-1274 - octobre 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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