Impact of Pharmacist Led Culture Review in the Emergency Department for Discharged Patients Warranting Antimicrobial Regimen Modification

Karall, Ian; Peksa, Gary D.; Starosta, Kate

doi:10.1093/ofid/ofw172.1445

Cited by 3 publications

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“…A calculated population size of 349 patients would provide 80% power and an alpha of 0.05 to detect a 15% difference in guideline‐appropriate antimicrobial management with pharmacist involvement (G*Power software, version 3.1) 11 . An effect size of 15% was selected based on previous literature and this institution's internal data 4,12 …”

Section: Methodsmentioning

confidence: 99%

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Evaluating the impact of emergency department clinical pharmacist integration within a discharge urine culture follow‐up program

Zhao

Stornelli

McAllister

et al. 2023

J Am Coll Clin Pharm

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IntroductionPatients are often discharged from the emergency department (ED) prior to final culture results, leading to the development of post‐ED discharge urine culture review programs (UCRPs) to ensure appropriate management. The purpose of this study was to evaluate the impact ED pharmacists have on antibiotic management and determine areas for improved antimicrobial stewardship efforts.MethodsThis was a single‐system, retrospective, quasi‐experimental study of patients who visited the ED for evaluation of a urinary tract infection comparing no pharmacist involvement in a culture review to a process when ED pharmacists were involved. Patients included those discharged from the ED requiring review under a UCRP. Incarcerated patients and those admitted to an inpatient service from the ED were excluded. The primary outcome was the receipt of guideline‐appropriate management. Secondary outcomes included unplanned admission or ED revisit within 14 and 30 days related to the initial ED visit, all‐cause hospital admission or ED revisit within 14 and 30 days, and acceptance rate of pharmacist recommendations.ResultsA total of 142 patients were included (before pharmacist integration = 70, after pharmacist integration = 72). Receipt of guideline‐appropriate management occurred at 33% without pharmacist integration and 85% in the arm with pharmacist integration, p < 0.001. Pharmacist recommendations were accepted in 97% of cases. No difference was noted between ED revisit within 14 and 30 days with a chief complaint directly related to the initial ED visit, 14 and 30 day admission related to the initial encounter, and all‐cause hospital admission or ED revisit within 14 and 30 days. In patients with asymptomatic bacteriuria, there was a higher receipt of inappropriate management 67% (20/30) in the time before pharmacist integration versus 19% (9/48) after pharmacist integration (p < 0.001).ConclusionThere was a significantly higher number of patients with appropriate antimicrobial management after pharmacist involvement in UCRP review.

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Section: Methodsmentioning

confidence: 99%

“…11 An effect size of 15% was selected based on previous literature and this institution's internal data. 4,12 Descriptive statistics were utilized for the overall population.…”

Section: Statisticsmentioning

confidence: 99%

Evaluating the impact of emergency department clinical pharmacist integration within a discharge urine culture follow‐up program

Zhao

Stornelli

McAllister

et al. 2023

J Am Coll Clin Pharm

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Expanding expedited partner therapy and HIV prophylaxis in the emergency department

Mercer,

Brizzi,

Burhoe

et al. 2023

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Sexually transmitted infections (STIs) continue to have a disproportionate impact on individuals belonging to sexual, gender, and racial minorities. Across the nation, many emergency medicine pharmacists (EMPs) possess the skills and knowledge to expand the provision of expedited partner therapy (EPT) for STIs and provide HIV prophylaxis within existing practice frameworks. This report serves as a call to action for expanded provision of EPT and HIV prophylaxis by EMPs and highlights current barriers and solutions to increase pharmacist involvement in these practice areas. Summary Emergency medicine pharmacy practice continues to expand to allow for limited prescribing authority through collaborative practice agreements (CPAs). In recent years, CPA restrictions have been changed to facilitate treatment of more patients with less bureaucracy. This report addresses the unique challenges and opportunities for expanding EPT and HIV pre- and postexposure prophylaxis provision by pharmacists in emergency departments (EDs). Furthermore, current strategies and treatments for EPT, such as patient-delivered partner therapy and HIV prophylaxis, are discussed. Pharmacist involvement in STI treatment and HIV prevention is a key strategy to increase access to high-risk populations with high ED utilization and help close current gaps in care. Conclusion Expanding EMP provision of EPT and HIV prophylaxis may be beneficial to reducing the incidence of STIs and HIV infection in the community. CPAs offer a feasible solution to increase pharmacist involvement in the provision of these treatments. Legislative efforts to expand pharmacist scope of practice can also contribute to increasing access to EPT and HIV prophylaxis. With these efforts, EMPs can play an essential role in the fight against STIs and HIV.

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Impact of Pharmacist Involvement in Post-Discharge Emergency Department Culture Review

Richardson,

Muhammad,

McSwain

et al. 2024

Hosp Pharm

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Background: Many infectious diseases are diagnosed in emergency departments (ED) and patients are prescribed antimicrobial therapy. Results from cultures typically take a few days to become finalized. Following up on these results is necessary when medication changes are indicated due to results that show bacteria are resistant to the prescribed antibiotics. Involving pharmacists in assessing the culture and sensitivity results, and making interventions when needed, is an innovative way to ensure that patients receive appropriate antimicrobial therapy based on the culture and sensitivity data. This study analyzed the impact of pharmacist involvement in the ED’s post-discharge positive culture review process on ED re-visits and hospitalizations. Methods: This single-center, pre- and post-implementation study examined the impact of pharmacist involvement in the post-ED visit culture review process on ED re-visits and hospitalizations. Positive microbiological results included documented growth from urine, skin and soft tissue, throat, blood, or stool cultures. Patients included in the study were of 18 years of age or older and had a positive culture result post ED-discharge. Patients were excluded from the study if they were admitted to the hospital or transferred to another facility. The primary outcomes included ED re-visits within 7 days and hospital readmissions within 30 days for the same condition. The secondary outcomes were percentage of pharmacist interventions accepted and types of pharmacist interventions implemented. Results: A total of 141 patients were included in the study, with 65 in the pre-implementation group and 76 in the post-implementation group. The primary outcome of ED re-visits within 7 days for the same condition occurred in 11 (17%) patients in the pre-implementation group and 5 (7%) patients in the post-implementation group ( P = .0454). The primary outcome of hospitalizations within 30 days for the same condition occurred in 5 (8%) patients in the pre-implementation group and 1 (1%) patient in the post-implementation group ( P = .0137). Seventeen (94%) out of the 18 pharmacist interventions were accepted and implemented. The intervention types implemented were to recommend to: change antibiotic (35%), not initiate antibiotic (24%), initiate antibiotic (24%), and continue antibiotic (18%). Conclusion: Pharmacist involvement in the ED post-discharge positive culture review process showed a decrease in ED re-visits and hospitalizations for the same condition.

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Impact of Pharmacist Led Culture Review in the Emergency Department for Discharged Patients Warranting Antimicrobial Regimen Modification

Cited by 3 publications

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Evaluating the impact of emergency department clinical pharmacist integration within a discharge urine culture follow‐up program

Evaluating the impact of emergency department clinical pharmacist integration within a discharge urine culture follow‐up program

Expanding expedited partner therapy and HIV prophylaxis in the emergency department

Impact of Pharmacist Involvement in Post-Discharge Emergency Department Culture Review

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