Impact of advanced practice pharmacists on a culture response program in the emergency department

Abstract

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Culture response programs are an important antimicrobial stewardship strategy in the emergency department. Pharmacists often have a key role in culture response but are most often dependent on other providers to optimize a patient’s antimicrobial therapy. This study assessed the impact of advanced practice pharmacists, with independent prescribing authority, on an emergency department culture response program. Methods This was a quasi-experimental preimplementation vs postimplementation evaluation performed at an academic medical center, with a 91-bed adult and pediatric emergency department, during the transition from a nurse-driven to an advanced practice pharmacist–driven program. The primary endpoint was time elapsed between initial culture review and intervention. Results Data on 200 interventions were collected from both the pre- and postimplementation phases. Median time from culture review to intervention was 5.26 hours (interquartile range [IQR], 21.39 hours) before implementation, compared to 2.95 hours (IQR, 4.7) after implementation (P < 0.001). The nurse-driven program intervened on 27% of positive cultures, while pharmacists intervened on 42% of positive cultures. The types of interventions performed and antibiotic prescribing patterns differed between the 2 study phases, but all choices were deemed appropriate by the criteria set for the purposes of this study. Conclusion The roles of advanced practice pharmacists allowed for the establishment of a streamlined culture response workflow. Culture responses occurred at a faster rate than with the previous nurse-driven program while maintaining high-quality clinical decision-making.

A Study Review of the Appropriateness of Oral Antibiotic Discharge Prescriptions in the Emergency Department at a Rural Hospital in Mississippi, USA

“…While there are recommendations from ASHP to utilize pharmacy services, we lack studies that address an antimicrobial stewardship program and the utility of pharmacy services in EDs. It has been shown through a few studies that one can decrease inappropriate drug regimens, reduce readmissions for the same diagnosis, and/or provide optimized patient care by having an EMP review ED discharge prescriptions [4][5][6][7][8][9][10][11][12][13][14][15]. However, these studies' interventions primarily involved the addition of the EMP to postdischarge culture reviews but there was no review by a pharmacist previously.…”