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Abstract:Objective. To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider.Interventions. Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider. Pharmacists in the VTE clinic work independently under a collaborative practice agreement. An evaluation of thirty-four patients, seventeen in each treatment arm, was conducted to compare the differences in treatment-related outcomes of rivaroxaban when managed by a pharmacist versus a primary care provider.Results. The primary endpoint was a six month composite of anticoagulation treatmentrelated complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication Accepted ArticleThis article is protected by copyright. All rights reserved.adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p=1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in 8 patients in the pharmacist group versus 0 patients in the control group. No differences were seen amongst other secondary endpoints.Conclusions. The pharmacist-managed clinic is a novel expansion of clinical pharmacy services that treats patients with low-risk VTEs with rivaroxaban in the outpatient setting.The evaluation of outcomes provides support that pharmacist-managed care utilizing standardized protocols under a collaborative practice agreement may be as safe as care by a primary care provider. Introduction:

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Background In an ideal state, the stewardship of antimicrobial agents would happen at the point of order entry. In June 2018, Eskenazi Health implemented a series of clinical decision support tools in the electronic health record (EHR), including required fields on all inpatient antimicrobial orders for indication, type of therapy (empiric or definitive), and duration. When empiric therapy is selected, providers receive a Best Practice Advisory (BPA) at 48 hours to re-evaluate therapy. Additionally, a side bar table was added to all antimicrobials orders that included drug-specific duration of therapy recommendations for common indications. Methods This is a single-center, retrospective, observational chart review that includes adult inpatients prescribed antibiotics for the treatment of CAP or UTI from July 2017 to December 2018. The primary outcome is the overall length of therapy between pre- and post-intervention groups for CAP and UTI. Secondary outcomes include duration of empiric/broad-spectrum therapy, duration of definitive therapy, time to de-escalation, length of hospital stay, C. difficile infections, 30-day readmission, and cost of antimicrobial therapy. Results A total of 541 orders were included for analysis. The composite overall duration of therapy decreased from 7 days to 5 days in the post-intervention group (p< 0.001). For CAP, the duration of therapy (5 days) was not different between groups. For UTI, the duration of therapy decreased from 11 days to 7 days in the post-intervention group (p< 0.001). The duration of empiric therapy decreased from 3 days to 2 days (p< 0.001) and the duration of definitive therapy decreased from 4 days to 3 days (p< 0.001). There was a 1 day longer length of stay for patients in the post-intervention group (p=0.038); however, there was a lower 30-day readmission rate in the post-intervention group (p=0.003). The rate of hospital-acquired C. difficile infections did not differ between groups (p=1.000). It was found that action was taken from the BPA 55.4% of the time after implementation. Conclusion The duration of therapy overall was shortened by 2 days, which was driven by the difference in duration for UTI. Incorporating antimicrobial stewardship principles at the point of order entry can result in fewer days of unnecessary therapy. Disclosures All Authors: No reported disclosures.