Medication errors are an all-too-common occurrence in emergency departments across the nation. This is largely secondary to a multitude of factors that create an almost ideal environment for medication errors to thrive. To limit and mitigate these errors, it is necessary to have a thorough knowledge of the medication-use process in the emergency department and develop strategies targeted at each individual step. Some of these strategies include medication-error analysis, computerized provider-order entry systems, automated dispensing cabinets, bar-coding systems, medication reconciliation, standardizing medication-use processes, education, and emergency-medicine clinical pharmacists. Special consideration also needs to be given to the development of strategies for the pediatric population, as they can be at an elevated risk of harm. Regardless of the strategies implemented, the prevention of medication errors begins and ends with the development of a culture that promotes the reporting of medication errors, and a systematic, nonpunitive approach to their elimination.
Positive outcomes of antimicrobial stewardship programs in the inpatient setting have been well documented, but the benefits for patients not admitted to the hospital remain less clear. This report describes a retrospective case-control study of patients discharged from the ED with subsequent positive cultures conducted to determine if integrating antimicrobial stewardship responsibilities into practice of the dedicated emergency medicine clinical pharmacist (EPh) decreased times to positive culture follow-up, patient or primary care provider (PCP) notification, and appropriateness of empiric or final antimicrobial therapy for patients discharged from the emergency department (ED). Pre-and post-implementation groups of an EPh-managed antimicrobial stewardship program were compared. Data were collected from medical records and the ED culture database. Continuous data were analyzed using Wilcoxon Rank Sum test and categorical data using Chi-squared analysis.
Positive cultures were identified in 177 patients, 104 and 73 in pre and post-implementation groups, respectively. Median time to culture review in the pre-implementation group was 3 days (range 1–15) and 2 days (range 0–4) in the post-implementation group (p=0.0001). There were positive cultures that required notification in 74 (71.2%) and 36 (49.3%) on pre- and post-implementation groups, respectively. Median time to patient or PCP notification was 3 days (range 1–9) in the pre-implementation group and 2 days(range 0–4) in the Eph managed program (p = 0.01). No difference in appropriate antimicrobial therapy was seen.
The authors of this study investigated if participation in Learning Community (LC) programs had an impact on the academic success and satisfaction of freshmen who attend a primarily commuter metropolitan university. The LC model used in this study clustered three courses together without thematic linkage or integration. A variety of methodologies were used to assess program impact, including matching learning community students to a control group on the basis of demographic information, academic information, major, and course-taking patterns. Some of the significant differences between the LC and non-LC students were that students who enrolled in LCs had higher grade point averages, earned more hours, were more satisfied with their college experiences, and were less likely to be placed on academic probation. This research demonstrates that LC programs which simply cluster courses can make significant differences in the lives of students who attend commuter campuses.
The practice of antimicrobial stewardship can be defined as optimizing clinical outcomes while minimizing the consequences of antimicrobial therapy such as resistance and superinfection. Antimicrobial stewardship can be difficult to transition to the emergency department (ED) since the traditional activities include the evaluation of broad-spectrum antimicrobial regimens at 72 and 96 hours and intravenous to oral medication conversion. The emergency medicine clinical pharmacist (EPh) has the knowledge and clinical assessment skills to manage an antimicrobial stewardship program focused on culture follow-up for patients discharged from the ED. This paper summarizes the experiences of developing an EPh-managed antimicrobial stewardship and culture follow-up program in the ED from 2 separate institutions. Specifically, the focus is on the steps for establishing an EPh-managed antimicrobial stewardship program, a description of the culture follow-up process, managing the culture data and cultures that require emergent notification and review, medical/legal concerns, and barriers to implementation. Outcomes data available from institutions with similar ED based antimicrobial stewardship programs are also discussed.
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