Affiliation:
1. Atrium Health Wake Forest Baptist , Winston-Salem, NC , USA
2. University of Kentucky Healthcare , Lexington, KY , USA
Abstract
Abstract
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 5.27 hours (interquartile range [IQR], 2.8-24.2 hours) before implementation, compared to 2.95 hours (IQR, 1.4-6.1) 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.
Publisher
Oxford University Press (OUP)
Subject
Health Policy,Pharmacology
Cited by
2 articles.
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