ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI

Lingenfelter, Erin; Drapkin, Zachary; Fritz, K; Youngquist, Scott T.; Madsen, Troy; Fix, Megan L.

doi:10.1016/j.ajem.2016.05.076

Cited by 22 publications

(11 citation statements)

References 17 publications

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“…Diante do exposto, salienta-se a importância da atuação do farmacêutico na equipe multiprofissional direcionado a cuidados intensivos, com o intuito de promover uma melhor assistência e colaborar para o incremento da segurança do paciente, além de propiciar resultados que influenciem diretamente nos indicadores em saúde 3,5,[12][13][14][15] . Entretanto, apesar da existência de uma vasta literatura internacional a respeito da atuação do farmacêutico clínico intensivista, no Brasil, estudos como este, são ainda escassos [3][4][5]11,14 .…”

Section: Introductionunclassified

Intervenções Farmacêuticas Em Uma Unidade De Terapia Intensiva De Um Hospital Universitário

Araujo¹,

Viapiana²,

Domingues³

et al. 2017

Rev. Bras. Farm. Hosp. Serv. Saúde

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Section: Introductionunclassified

Intervenções Farmacêuticas Em Uma Unidade De Terapia Intensiva De Um Hospital Universitário

Araujo¹,

Viapiana²,

Domingues³

et al. 2017

Rev. Bras. Farm. Hosp. Serv. Saúde

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“…Other antimicrobial stewardship efforts seen in the ambulatory care setting have demonstrated improvements in antibiotic prescribing, though they have not been pharmacist driven 11,16‐20 . One study looked at the effects of a letter posted in patient rooms emphasizing clinician commitment to guideline appropriate antibiotic prescribing compared to a control group 12 .…”

Section: Discussionmentioning

confidence: 99%

Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections

et al. 2020

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What is known and Objective Currently, there are limited data on ambulatory antimicrobial stewardship (AAMS) programmes in the primary care setting. The purpose of this study was to implement a pharmacist‐led AAMS programme for uncomplicated cystitis (UC) and pyelonephritis in a hospital‐based family medicine residency clinic. Methods A retrospective cohort study was used to assess clinician prescribing habits and identify areas of inappropriate prescribing. Females between 18 and 64 years old diagnosed with UC or pyelonephritis were included in the analysis. The primary objective was a composite of appropriate choice of antibiotic based on first‐line recommendations, appropriate dose and appropriate duration of therapy. The intervention included development of a guideline‐based antibiotic treatment summary accessible in the electronic health record (EHR), clinician education sessions for medical residents and faculty, and treatment defaults in the EHR. Results and Discussion Eighty‐one patients were included in the pre‐intervention group and 81 in the post‐intervention group. In the pre‐intervention group, 37% of patients met the composite primary outcome vs. 71.6% in the post‐intervention group (P < .001) for UC and pyelonephritis combined. This was primarily driven by improvement in appropriate duration of therapy for both diagnoses which increased from 44.4% to 84.0% (P < .001). What is new and Conclusions A pharmacist‐led AAMS programme significantly improved guideline‐based treatment adherence for UC and pyelonephritis based on the composite of appropriate choice of antibiotic, appropriate dose and appropriate duration of therapy in a primary care family medicine setting.

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“…Previous studies describing ASP interventions in the ED have been limited in scope to uncomplicated UTIs and consequently focused on a lower-risk patient population than that seen in our study [ 18 , 21 , 22 , 34 , 35 ]. In contrast, we sought to address the needs of our diverse ED population comprised of patients with varying levels of comorbidity and index infection severity.…”

Section: Discussionmentioning

confidence: 99%

“…Rather than using conventional educational messaging that emphasizes the public health threat of antimicrobial resistance, which has been shown to have modest effects on motivating practice change [ 36 ], we instead focused on emphasizing opportunities to improve outcomes in our own patient population. We believe that our study contributes to the growing body of literature showing that the most convincing data to motivate change in practice are those measured at the institutional level, beginning with characterizing the target patient population, antimicrobial resistance patterns, and prescribing behavior and, finally, measuring outcomes related to infection [ 7 , 9 , 11 , 21 , 22 , 34 ]. Although we did not quantify how often our algorithm was used to guide prescribing, feedback and requests for clarification in reference to the algorithm from ED clinicians suggest that it was being considered or utilized for the care of patients with UTI.…”

Section: Discussionmentioning

confidence: 99%

Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

Jorgensen

Yeung

Zurayk

et al. 2018

Open Forum Infectious Diseases

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BackgroundThe complex and fast-paced emergency department (ED) practice setting presents unique challenges that demand a tailored approach to antimicrobial stewardship. In this article, we describe the strategies applied by 1 institution’s antimicrobial stewardship program (ASP) that were successful in improving prescribing practices and outcomes for urinary tract infection (UTI) in the ED.MethodsCore strategies included pre-implementation research characterizing the patient population, antimicrobial resistance patterns, prescribing behavior, and morbidity related to infection; collaboration across multiple disciplines; development and implementation of a UTI treatment algorithm; education to increase awareness of the algorithm and the background and rationale supporting it; audit and feedback; and early evaluation of post-implementation outcomes.ResultsWe observed a rapid change in prescribing post-implementation with increased empiric nitrofurantoin use and reduced cephalosporin use (P < .05). Our elevation of nitrofurantoin to firstline status was supported by our post-implementation analysis showing that its use was independently associated with reduced 30-day return visits (adjusted odds ratio, 0.547; 95% confidence interval, 0.312–0.960). Furthermore, despite a shift to a higher risk population and a corresponding decrease in antimicrobial susceptibility rates post-implementation, the preferential use of nitrofurantoin did not result in higher bug-drug mismatches while 30-day return visits to the ED remained stable.ConclusionsWe demonstrate that an outcomes-based ASP can impart meaningful change to knowledge and attitudes affecting prescribing practices in the ED. The success of our program may be used by other institutions as support for ASP expansion to the ED.

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ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI

Cited by 22 publications

References 17 publications

Intervenções Farmacêuticas Em Uma Unidade De Terapia Intensiva De Um Hospital Universitário

Intervenções Farmacêuticas Em Uma Unidade De Terapia Intensiva De Um Hospital Universitário

Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections

Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes

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