Pharmacists are increasingly using medication therapy problem (MTP) metrics to monitor their clinical impact and demonstrate their value to health care organizations and commercial payers. Although the practice of documenting and resolving MTPs is well reported in the literature, there remains great diversity in how MTPs are categorized, documented, and reported. We conducted a review of the literature to gain key insights into the MTP classification systems, methods of MTP documentation, and MTP-related outcomes that are reported in the literature, as well as the elements of MTP documentation that are commonly employed in practice. Ninety-one articles were identified. These insights were used to develop a set of recommendations to help standardize the practice of MTP documentation in the profession. This review highlights the findings from these studies and outlines a set of recommendations for identifying, categorizing, documenting, and monitoring MTPs that can be applied across care settings. The recommendations include clearly defining the purpose for documenting MTPs; using an established, standardized MTP categorization framework and applying that framework consistently in practice; establishing a clear process for identifying and resolving MTPs; systematizing the documentation and reporting process; tracking the resolution of MTPs identified; and monitoring MTP data and assessing impact. MTP identification, documentation, and reporting are an important strategy for capturing, monitoring, and sharing the unique contributions of pharmacists in providing patient care. Although additional research is needed to clearly demonstrate the relationship between MTPs and humanistic, clinical, and economic outcomes, MTP resolution may be a useful process metric to demonstrate the value-added role of the pharmacist in the delivery of team-based, patient-centered care.clinical pharmacy services, drug, health care, medication therapy management, outcome and process assessment | INTRODUCTIONThe primary goal of health care is to improve the health and wellbeing of patients. Medications play a significant role in the prevention and treatment of short-term and long-term therapy disease, and pharmacists are uniquely poised as highly educated and trained medication specialists to optimize medication use and improve the health of patients. 1 Through the provision of comprehensive medication management (CMM), pharmacists helps ensure patients' medications are appropriate, effective, and safe, and that patients are adhering to
Background The objective of this study was to confirm the validity of institution specific treatment recommendations targeting organisms identified by GenMark Dx® ePlex® blood cultures identification (BCID) Gram-negative panel prior to susceptibility results. Methods We developed and implemented institution specific guidelines for empiric antibiotic therapy for Gram-negative organisms targeted by GenMark Dx® ePlex® BCID. We utilized blood culture antibiograms, existing evidence for the most optimal agent for each pathogen, probable resistance mechanisms and patient clinical status to create these guidelines. From December 16, 2019 through May 31, 2020, infectious diseases pharmacists reviewed all positive blood cultures; assessed compliance with guidelines and intervened as needed. The primary objective was to determine how frequently guideline recommend agents would be ineffective against targeted pathogens based on susceptibilities. Secondary objectives were compliance with guidelines and frequency of therapy escalation or de-escalation. Results GenMark® testing was completed on 222 cultures positive for Gram-negative rods with target organisms identification in 195 (88%) blood cultures. Two hundred and five organisms were identified; most commonly E. coli (40%) and K. pneumoniae (21%).Resistance markers were detected in 30 aerobic blood cultures; 28 CTX-M, and 2 KPC. Our institutional guideline provided appropriate empiric coverage in 93% of bacteremia episodes. The most common reason for ineffective therapy was the presence of resistance mechanisms not detected by GenMark® test (e.g. non-CTX-M extended spectrum beta-lactamases). The compliance rate with the guidelines was 55%; the most common reason for non-compliance was the use of an anti-pseudmonal beta-lactams in neutropenic patients.. The system failed to identify panel organisms in only 5 (2%) of blood cultures. Conclusion The institution-specific guidelines providing empiric coverage for each organism identified by rapid diagnostic tests can aid antimicrobial stewardship efforts to de-escalate therapy while still providing effective coverage in >90% of cases. Disclosures All Authors: No reported disclosures.
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