Background: Despite widespread recognition of the need for innovative pharmacy practice approaches, the development and implementation of value-based outcomes remains difficult to achieve. Furthermore, gaps in the literature persist because the majority of available literature is retrospective in nature and describes only the clinical impact of pharmacists’ interventions. Objective: Length of stay (LOS) is a clinical outcome metric used to represent efficiency in health care. The objective of this study was to evaluate the impact of pharmacist-driven interventions on LOS in the acute care setting. Methods: A separate samples pretest-posttest design was utilized to compare the effect of pharmacist interventions across 3 practice areas (medicine, hematology/oncology, and pediatrics). Two time periods were evaluated: preimplementation (PRE) and a pilot period, postimplementation of interventions (POST). Interventions included targeted discharge services, such as discharge prescription writing (with provider cosignature). Participating pharmacists completed semistructured interviews following the pilot. Results: A total of 924 patients (466 PRE and 458 POST) were included in the analysis. The median LOS decreased from 4.95 (interquartile range = 3.24-8.5) to 4.12 (2.21-7.96) days from the PRE versus POST groups, respectively ( P < 0.011). There was no difference in readmission rates between groups (21% vs 19.1%, P = 0.7). Interviews revealed several themes, including positive impact on professional development. Conclusion and Relevance: This pilot study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists’ responsibilities. This study is novel in targeting LOS, providing a value-based outcome for clinical pharmacy services.
This is a case report of a 75-year-old immunocompromised male who developed encephalopathy while undergoing treatment for disseminated herpes zoster with peripheral nerve involvement. While his initial presentation involved primarily profound lower extremity weakness, he developed progressive confusion to the point of obtundation only after initiation of standard therapy with intravenous acyclovir. The evaluation of his altered mental status was largely unremarkable. It was only after his acyclovir was discontinued that his symptoms resolved and he returned to his baseline mental status. His presentation was most consistent with acyclovir-induced neurotoxicity, which can present in patients with renal impairment and those who are immunocompromised.
BackgroundHospitalized patients who require Infectious Diseases (ID) consultative services and are discharged on antimicrobials (AM) are medically complex and at high risk of readmission. Complications related to AM toxicity, suboptimal regimen completion, or lack of AM access are prevalent. Our ID clinic pharmacist contacted patients affiliated with ID services within 72 hours of discharge to identify and intervene on needs such as AM access and management, toxicity monitoring, AM administration teaching, and to assess discharge care progression. The goal of this intervention was to leverage the subject matter expertise of an ID-trained pharmacist to create a protocolized intervention to improve the inpatient-to-outpatient transition for ID patients.MethodsDuring a 12 week time period, 173 patients were identified and enrolled in the ID DOOR intervention. Patients who received consultative care by an ID physician were tracked and automatically referred to ID DOOR; those discharged on antimicrobials were included in the intervention group. Phone-based assessment of discharge AM access, education, and administration was initiated by the ID pharmacist within 72 hours of discharge (Table 1).ResultsOf the 173 patients, 155 (90%) were successfully contacted post-discharge. The majority of needs identified were AM education, access, and coordination of care (Table 2). In addition, discrepancies between discharge orders, summary content, and patient instructions were prevalent. Based on the medication-related assessment performed by the ID-trained pharmacists, they were able to resolve AM-related issues and identify, triage, and link patients to appropriate multidisciplinary providers to coordinate care plans.ConclusionThe data highlight the prevalence of immediate post-discharge needs related to antimicrobial for patients and the critical role of ID-trained pharmacists in addressing these needs. In a large public academic medical center with uninsured and underinsured patients, additional support for AM access, education, and navigation of care plans is needed. For medically and socially complex ID patients, an ID-trained pharmacist plays a critical role in reducing risk inherent in the transition from inpatient to outpatient care. Disclosures All authors: No reported disclosures.
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