Urine culture guided antibiotic interventions: A pharmacist driven antimicrobial stewardship effort in the ED

Zhang, Xi; Rowan, Nicole; Pflugeisen, Bethann M.; Alajbegovic, Sanjin

doi:10.1016/j.ajem.2016.12.036

Cited by 52 publications

(39 citation statements)

References 17 publications

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“…Culture follow‐up after ED discharge is defined as the review of microbiologic data on patients discharged from the ED to ensure appropriate antimicrobial therapy is provided. Although no CA data are available for this indication, one study evaluating a pharmacist‐driven ED antimicrobial stewardship initiative demonstrated a reduction in antimicrobial days by 119 days in 58 patients with pharmacist intervention . Other potential actions include initiation of therapy, dosage adjustment, clarifying an antimicrobial medication order, and providing medication teaching.…”

Section: Results Of Scoping Reviewmentioning

confidence: 99%

“…Although no CA data are available for this indication, one study evaluating a pharmacist-driven ED antimicrobial stewardship initiative demonstrated a reduction in antimicrobial days by 119 days in 58 patients with pharmacist intervention. 74 Other potential actions include initiation of therapy, dosage adjustment, clarifying an antimicrobial medication order, and providing medication teaching. Therefore, a conservative estimate for this activity is the cost of clarifying a drug order (antimicrobial) that equates to $631.34 per patient.…”

Section: Culture Follow-up After Ed Discharge (Loe Iv)mentioning

confidence: 99%

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Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

et al. 2019

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A framework for evaluating pharmacists’ impact on cost avoidance in the intensive care unit (ICU) and emergency department (ED) has not been established. This scoping review was registered (CRD42018091217) and conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED. Searches were conducted in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until April 2018. The level of evidence (LOE) for each specific category of intervention was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation evidence‐to‐decision framework. The risks of bias for articles were evaluated using Newcastle Ottawa and Cochrane Collaboration tools. The values from all interventions were inflated to 2018 U.S. dollars using the consumer price index for medical care. Of the 464 articles initially identified, 371 were excluded and 93 were included. After reviewing references from the articles included, an additional 71 articles were also reviewed. The 38 cost intervention categories were supported by varying LOEs: IA (0 categories), IB (1 category), IIA (4 categories), IIB (0 categories), III (27 categories), and IV (6 categories), and articles mostly displayed low to moderate risks of bias. Pharmacists generate cost avoidance through a variety of interventions in critically and emergently ill patients. The quality of evidence supporting specific cost avoidance values is generally low. Quantification of and factors associated with the cost avoidance generated from pharmacists caring for these patients are of paramount importance.

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Section: Results Of Scoping Reviewmentioning

confidence: 99%

Section: Culture Follow-up After Ed Discharge (Loe Iv)mentioning

confidence: 99%

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

et al. 2019

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“…No increases in treatment failures or adverse events were observed as a result of the intervention. Zhang et al focused on implementation of a pharmacist-led review of all urine cultures with recommendations made to the provider if the patient was non-pregnant and was deemed to have asymptomatic bacteriuria [16]. Of 457 encounters reviewed, 136 patients were found to meet criteria for asymptomatic bacteriuria.…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

et al. 2019

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Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED.

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“…The published studies on influenza are consistent with the success pharmacists have demonstrated in judiciously managing antimicrobials for patients with Group A Streptococcal pharyngitis and urinary tract infections …”

Section: Key Areas Of Concern From Stakeholdersmentioning

confidence: 99%

Pharmacy-based management of influenza: lessons learned from research

Klepser

Adams

2018

International Journal of Pharmacy Practice

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Recently, several jurisdictions have pursued legislative and regulatory changes to allow pharmacy‐based influenza management models in which pharmacists can initiate appropriate antiviral therapy in community pharmacy settings. While studies have been published in Canada, Japan, New Zealand, Norway and the United States, concerns have been expressed over pharmacist training, the accuracy of rapid influenza diagnostic tests, and the potential impact on antimicrobial resistance, among others. Studies have demonstrated that pharmacists provide safe and effective influenza management, with high rates of patient satisfaction, while maintaining or improving antimicrobial stewardship.

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Urine culture guided antibiotic interventions: A pharmacist driven antimicrobial stewardship effort in the ED

Cited by 52 publications

References 17 publications

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

Pharmacy-based management of influenza: lessons learned from research

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