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Sapozhnikov J, Albarillo FS, Pulia MS. Optimizing Antimicrobial Stewardship in the Emergency Department. Emerg Med Clin North Am 2024; 42:443-459. [PMID: 38641398 DOI: 10.1016/j.emc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Antibiotic stewardship is a core component of emergency department (ED) practice and impacts patient safety, clinical outcomes, and public health. The unique characteristics of ED practice, including crowding, time pressure, and diagnostic uncertainty, need to be considered when implementing antibiotic stewardship interventions in this setting. Rapid advances in pathogen detection and host response biomarkers promise to revolutionize the diagnosis of infectious diseases in the ED, but such tests are not yet considered standard of care. Presently, clinical decision support embedded in the electronic health record and pharmacist-led interventions are the most effective ways to improve antibiotic prescribing in the ED.
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Affiliation(s)
- Julia Sapozhnikov
- Medical Science Liaison, Karius Inc, 975 Island Drive, Redwood City, CA 94065, USA
| | - Fritzie S Albarillo
- Department of Medicine, Infectious Diseases Division, Loyola University Medical Center, Loyola University Medical Center is 2160 South First Avenue, Maywood, IL 60153, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 300, Madison, WI 53705, USA.
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2
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Wang Y, Knobloch K, Lovett S, Lyons N, Rech MA. A pharmacist-driven deprescribing protocol for negative urine and sexually transmitted infection cultures in the emergency department increases antibiotic-free days. Am J Health Syst Pharm 2024; 81:e83-e89. [PMID: 37878503 DOI: 10.1093/ajhp/zxad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Emergency department (ED) pharmacists commonly perform positive culture follow-ups that result in optimized antibiotic prescribing. The purpose of this study was to evaluate the potential positive impact on the outcome of antibiotic-free days through an ED pharmacist-driven protocol to contact patients with negative urine cultures and sexually transmitted infection (STI) test results who were discharged with antibiotics. METHODS This was a single-center, prospective, observational, pre-post intervention study to determine antibiotic use in patients with negative urine cultures who were discharged from the Loyola Medical University Center ED with antibiotics prescribed. Patients were identified through daily positive culture reports. The primary outcome was days free of antibiotics, defined as the number of calendar days within 28 days after urine culture or STI test collection on which the patient did not receive any antibiotic treatments. RESULTS One hundred ninety-two patients were screened. Sixty-three and twenty-six patients met the inclusion criteria in the pre- and postintervention groups, respectively. The study identified 163/465 (35.1%) antibiotic free days for the preintervention group, compared to 150.5/187 (80.5%) antibiotic-free days for the postintervention group. A majority of the patients did not have urinary tract infection as the chief complaint. The most common urinary and STI symptoms upon ED admission in the pre- and postintervention groups were dysuria (19.2% vs 28.1%) and unusual discharge (30.8% vs 28.6%), respectively. CONCLUSION This study showed that a pharmacist-driven protocol increased the number of antibiotic-free days for patients prescribed empiric antibiotic therapy and discharged from the ED with subsequent negative urine cultures and STI results. We propose taking a novel approach in discontinuation of antibiotics by implementing an expansion of ED culture programs to include negative cultures that promote antimicrobial stewardship.
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Affiliation(s)
- Yifan Wang
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Karlie Knobloch
- Department of Pharmacy, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Shannon Lovett
- Department of Emergency Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Neal Lyons
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Megan A Rech
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Emergency Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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3
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Le G, Ivy M, Dickey S, Welch R, Stallings D. A Study Review of the Appropriateness of Oral Antibiotic Discharge Prescriptions in the Emergency Department at a Rural Hospital in Mississippi, USA. Antibiotics (Basel) 2023; 12:1186. [PMID: 37508282 PMCID: PMC10376222 DOI: 10.3390/antibiotics12071186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Antimicrobial therapy in emergency departments (EDs) is usually empiric in nature. Due to workload and a goal to reduce patient wait times, providers often make rapid decisions regarding antibiotic prescriptions for discharge. A review of current empiric prescribing practices would determine the appropriateness of oral antibiotic discharge prescriptions from EDs. A single-center retrospective electronic health record review of all adult patients with an ED visit from 1 June 2019, to 30 June 2021 who received at least one oral antibiotic prescription at discharge from Baptist Memorial Hospital-Golden Triangle was conducted. The primary outcome was the assessment of appropriate antibiotic discharge prescriptions. The parameters for appropriateness included empiric drug selection, dosage, frequency, duration, and subsequent cultures and sensitivities. Of the 18,289 identified records, 421 patients were randomly sampled with 400 patients included in the final analysis. Of these, 190 (47.8%) discharge oral antibiotic prescriptions were assessed as appropriate and 209 (52.3%) discharge oral antibiotic prescriptions were assessed as inappropriate based on the guideline recommendations. With approximately half of the patients receiving discharge antibiotics that did not fully follow the guideline recommendations, there is a need for provider education, pharmacist intervention, and antimicrobial stewardship programs focusing on this practice.
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Affiliation(s)
- Giang Le
- Department of Pharmacy, Baptist Memorial Hospital-Golden Triangle, Columbus, MS 39705, USA
| | - Madalyn Ivy
- Department of Pharmacy, Baptist Memorial Hospital-Golden Triangle, Columbus, MS 39705, USA
| | - Sharon Dickey
- Department of Pharmacy, Baptist Memorial Hospital-Golden Triangle, Columbus, MS 39705, USA
| | - Ron Welch
- Department of Pharmacy, Baptist Memorial Hospital-Golden Triangle, Columbus, MS 39705, USA
| | - Danielle Stallings
- Department of Pharmacy, Baptist Memorial Hospital-Golden Triangle, Columbus, MS 39705, USA
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4
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Benson M, Dewey M, Friesner D. Pharmacist-Led Urine Culture Follow-Ups in a Rural Emergency Department. J Am Pharm Assoc (2003) 2022:S1544-3191(22)00289-8. [DOI: 10.1016/j.japh.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
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5
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Greenwood D, Tully MP, Martin S, Steinke D. Development of the Manchester framework for the evaluation of emergency department pharmacy services. Int J Clin Pharm 2022; 44:930-938. [PMID: 35449350 PMCID: PMC9393142 DOI: 10.1007/s11096-022-01403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many countries, including the United Kingdom, have established Emergency Department (ED) pharmacy services where some ED pharmacists now work as practitioners. They provide both traditional pharmaceutical care and novel practitioner care i.e. clinical examination, yet their impact on quality of care is unknown. AIM To develop a framework of structures, processes and potential outcome indicators to support evaluation of the quality of ED pharmacy services in future studies. METHOD Framework components (structures, processes and potential outcome indicators) were identified in three ways: from a narrative review of relevant international literature, and separate panel meetings with ED pharmacists and then other ED healthcare professionals. Structures and processes were collated into categories developed iteratively throughout data collection, with outcome indicators collated into six domains of quality as proposed by the Institute of Medicine. These raw data were then processed e.g. outcome indicators screened for clarity i.e. those which explicitly stated what would be measured were included in the framework. RESULTS A total of 190 structures, 533 processes, and 503 outcome indicators were identified. Through data processing a total of 153 outcome indicators were included in the final framework divided into the domains safe (32), effective (50), patient centred (18), timely (24), efficient (20) and equitable (9). CONCLUSION The first framework specific to the quality evaluation ED pharmacy services, service evaluators should validate potential outcome indicators prior to their use. The minimum expected of a high-quality service should also be defined to enable interpretation of relevant measurements.
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Affiliation(s)
- D Greenwood
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT, Manchester, UK. .,School of Medicine, Anglia Ruskin University, Bishop Hall Lane, CM1 1SQ, Chelmsford, UK.
| | - MP Tully
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT Manchester, UK
| | - S Martin
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT Manchester, UK ,School of Pharmacy and Medical Sciences, University of Bradford, Richmond Road, BD7 1DP Bradford, UK
| | - D Steinke
- Division of Pharmacy and Optometry, University of Manchester, Oxford Road, M13 9PT Manchester, UK
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6
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Ortmann MJ, Johnson EG, Jarrell DH, Bilhimer M, Hayes BD, Mishler A, Pugliese RS, Roberson TA, Slocum G, Smith AP, Yabut K, Zimmerman DE. ASHP Guidelines on Emergency Medicine Pharmacist Services. Am J Health Syst Pharm 2021; 78:261-275. [PMID: 33480409 DOI: 10.1093/ajhp/zxaa378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Daniel H Jarrell
- Department of Pharmacy, Banner - University Medical Center Tucson, Tucson, AZ.,Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ
| | - Matt Bilhimer
- Department of Pharmacy, Olathe Medical Center, Olathe, KS
| | - Bryan D Hayes
- Department of Emergency Medicine, Harvard Medical School, Boston, MA.,Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Aimee Mishler
- Department of Pharmacy, Valleywise Health, Phoenix, AZ
| | - Robert S Pugliese
- Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, PA.,Department of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Taylor A Roberson
- Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, OH
| | - Giles Slocum
- Department of Pharmacy and Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Andrew P Smith
- Department of Pharmacy, Scripps Mercy Hospital, San Diego, CA
| | - Katie Yabut
- Department of Pharmacy, Legacy Mount Hood Medical Center, Portland, OR
| | - David E Zimmerman
- Department of Pharmacy, Duquesne University School of Pharmacy, Pittsburgh, PA.,Department of Pharmacy, UPMC-Mercy, Pittsburgh, PA
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7
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Bouza E, Brenes FJ, Díez Domingo J, Eiros Bouza JM, González J, Gracia D, Juárez González R, Muñoz P, Petidier Torregrossa R, Ribera Casado JM, Ramos Cordero P, Rodríguez Rovira E, Sáez Torralba ME, Serra Rexach JA, Tovar García J, Verdejo Bravo C, Palomo E. The situation of infection in the elderly in Spain: a multidisciplinary opinion document. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:327-349. [PMID: 32896115 PMCID: PMC7528417 DOI: 10.37201/req/057.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 11/10/2022]
Abstract
Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.
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Affiliation(s)
- E Bouza
- Emilio Bouza, Instituto de Investigación Sanitaria Gregorio Marañón. C/ Dr. Esquerdo, 46 28007 Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Palomo
- Esteban Palomo, Director. Health Sciences Foundation. C/ Severo Ochoa 2 - 28760 Tres Cantos. Madrid. Phone +34 91 3530150
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Maddali N, Cantin A, Koshy S, Eiting E, Fedorenko M. Antibiotic prescribing patterns for adult urinary tract infections within emergency department and urgent care settings. Am J Emerg Med 2020; 45:464-471. [PMID: 33067064 DOI: 10.1016/j.ajem.2020.09.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
Urinary tract infections (UTI) are a common reason for emergency department (ED) and urgent care (UC) visits. Fluoroquinolones (FQ) are frequently prescribed for treatment of UTI in the outpatient setting; however, data evaluating prescribing patterns after FDA safety warnings is limited, especially in UC. The study goal was to investigate and compare antimicrobial prescribing for UTIs in a single-site ED and an off-site UC in an urban, academic health system. This retrospective study included patients presenting with a UTI to the ED or UC between January and June 2018. Those 18 years or older with uncomplicated, complicated UTI, or pyelonephritis were included. Exclusion criteria were catheter-related UTI, urinary tract abnormalities, immunocompromised, or hospitalization. Primary outcome was FQ prescribing rate for all UTI in the ED and UC. Secondary outcomes were rates of non-FQ prescribing, re-presentation, bug-drug mismatch, and treatment durations. 184 patients were included. FQ prescribing rate was similar in ED and UC (21.2% vs. 16.3%, p = 0.4). Non-FQs prescribed in ED and UC were nitrofurantoin (20.2% vs 53.6%), beta-lactams (46.1% vs 22.6%), and trimethoprim/sulfamethoxazole (12.5% vs. 5%). A longer than recommended duration was identified in 46.3% UC patients compared to 21.2% ED patients. Thirty-day re-presentation with persistent UTI symptoms occurred more frequently in the ED compared to UC (13.5% vs. 7.5%). Predictors of FQ prescribing on logistic regression were male, recurrent UTI, and malignancy. FQ prescribing rate for UTI treatment was low with no difference between ED and UC. Opportunity exists to improve treatment duration and antimicrobial choice.
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Affiliation(s)
- Navya Maddali
- Department of Pharmacy, Mount Sinai Beth Israel, New York, NY, United States.
| | - Amanda Cantin
- Department of Pharmacy, Mount Sinai Beth Israel, New York, NY, United States
| | - Sanjana Koshy
- Division of Infectious Diseases, Mount Sinai Beth Israel, New York, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erick Eiting
- Department of Emergency Medicine, Mount Sinai Beth Israel, New York, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marianna Fedorenko
- Department of Pharmacy, Mount Sinai Beth Israel, New York, NY, United States
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9
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McCormick JZ, Cardwell SM, Wheelock C, Wong CM, Vander Weide LA. Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections. J Clin Pharm Ther 2020; 45:1312-1319. [DOI: 10.1111/jcpt.13210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Julia Z. McCormick
- Department of Pharmacy PeaceHealth Family Medicine of Southwest Washington Vancouver WA USA
| | - Sophia M. Cardwell
- Department of Pharmacy PeaceHealth Southwest Medical Center Vancouver WA USA
| | | | - Carolyn M. Wong
- Department of Pharmacy PeaceHealth Family Medicine of Southwest Washington Vancouver WA USA
| | - Luke A. Vander Weide
- Department of Pharmacy PeaceHealth Family Medicine of Southwest Washington Vancouver WA USA
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10
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Werneburg GT. EDITORIAL COMMENT. Urology 2020; 136:125-126. [DOI: 10.1016/j.urology.2019.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
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11
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Liang SY, Camins BC. Urine Culture and Uncomplicated Cystitis: A Bigger Picture? Ann Emerg Med 2020; 73:308-309. [PMID: 30797295 DOI: 10.1016/j.annemergmed.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Bernard C Camins
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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12
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Abstract
Urinary tract infection (UTI) affects patients of all ages and is a diagnosis that emergency physicians might make multiple times per shift. This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients.
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Sakeena MHF, Bennett AA, McLachlan AJ. The Need to Strengthen the Role of the Pharmacist in Sri Lanka: Perspectives. PHARMACY 2019; 7:E54. [PMID: 31195755 PMCID: PMC6631506 DOI: 10.3390/pharmacy7020054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/15/2022] Open
Abstract
The role of the pharmacist in healthcare has evolved greatly over the last half-century, from dispensing to providing direct patient-oriented activities not associated with dispensing. However, pharmacist-led healthcare services in Sri Lanka must undergo reform to fully take advantage of their expertise and training in medicine management and related outcomes in Sri Lankan patients. As befits a profession's role development and value, professional and educational standards for pharmacists need ongoing development and growth. Currently, university curricula and continuing professional education in Sri Lanka require further development and optimisation to provide the theoretical and practical knowledge and skills regarding quality use of medicines and patient-oriented care. Furthermore, pharmacists' roles in Sri Lankan hospital and community pharmacist settings need to be recognised and should include the pharmacist as an integral part of the multidisciplinary healthcare team in Sri Lanka. Studies from developed countries and some developing countries have demonstrated that expanded pharmacists' roles have had a significant positive cost-effective impact on the population's health. Therefore, the availability of qualified Sri Lankan pharmacists trained to deliver expanded professional services accompanied by greater pharmacist integration into healthcare delivery is crucially important to ensure quality use of medicines within the Sri Lankan healthcare system and optimise the medication-related needs of Sri Lankans.
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Affiliation(s)
- M H F Sakeena
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya KY 20400, Sri Lanka.
- Sydney Pharmacy School, The University of Sydney, New South Wales 2006, Australia.
| | | | - Andrew J McLachlan
- Sydney Pharmacy School, The University of Sydney, New South Wales 2006, Australia.
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Abstract
The emergency department (ED) is the hub of the US health care system. Acute infectious diseases are frequently encountered in the ED setting, making this a critical setting for antimicrobial stewardship efforts. Systems level and behavioral stewardship interventions have demonstrated success in the ED setting but successful implementation depends on institutional support and the presence of a physician champion. Antimicrobial stewardship efforts in the ED should target high-impact areas: antibiotic prescribing for nonindicated respiratory tract conditions, such as bronchitis and sinusitis; overtreatment of asymptomatic bacteriuria; and using two antibiotics (double coverage) for uncomplicated cases of cellulitis or abscess.
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Affiliation(s)
- Michael Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Drive, Suite 300, Madison, WI 53705, USA.
| | - Robert Redwood
- Department of Family Medicine and Community Health, University of Wisconsin Madison School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715
| | - Larissa May
- Department of Emergency Medicine, University of California Davis, 4150 V Street, Suite 2100, Sacramento, CA 95817, USA
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15
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Community pharmacy interventions to improve antibiotic stewardship and implications for pharmacy education: A narrative overview. Res Social Adm Pharm 2018; 15:627-631. [PMID: 30279131 DOI: 10.1016/j.sapharm.2018.09.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antibiotic resistance is one of the world's most pressing public health problems, resulting in over 23,000 deaths per year. One of the main contributing factors to antimicrobial resistance is antibiotic misuse and overuse. Community pharmacists can play a role in reducing antibiotic resistance, since they are one of the most accessible healthcare professionals. OBJECTIVE The purpose of this paper is to describe community pharmacy interventions and strategies to reduce antibiotic misuse and overuse and to discuss the implications for pharmacy training. METHODS A narrative overview strategy was employed to identify papers on antibiotic stewardship and the role of the community pharmacist. Our review examined potential stewardship strategies and interventions within community pharmacy practice that provide opportunities for pharmacists to engage or lead in the reduction of antimicrobial resistance. RESULTS We describe five promising community pharmacist-led intervention strategies: Collaborative Practice Agreements (CPAs), point-of-care (POC) testing, patient consultations, academic detailing and serving as an advocate for patients and other healthcare providers CONCLUSIONS: This review highlights topics that may warrant increased attention in pharmacy school curricula. Pharmacy schools may want to consider modifying their curricula to address the shifts in practice of the community pharmacist - emphasizing the expanded role of the pharmacist in patient care and public health issues such as outpatient antibiotic stewardship.
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16
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Jorgensen SCJ, Yeung SL, Zurayk M, Terry J, Dunn M, Nieberg P, Pallares J, Wong-Beringer A. Leveraging Antimicrobial Stewardship in the Emergency Department to Improve the Quality of Urinary Tract Infection Management and Outcomes. Open Forum Infect Dis 2018; 5:ofy101. [PMID: 29977961 PMCID: PMC6016416 DOI: 10.1093/ofid/ofy101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The 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. METHODS Core 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. RESULTS We 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. CONCLUSIONS We 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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Affiliation(s)
- Sarah C J Jorgensen
- Department of Pharmacy, Huntington Hospital, Pasadena, California
- University of Southern California, School of Pharmacy, Los Angeles, California
| | - Samantha L Yeung
- University of Southern California, School of Pharmacy, Los Angeles, California
| | - Mira Zurayk
- Department of Pharmacy, Huntington Hospital, Pasadena, California
| | - Jill Terry
- Department of Pharmacy, Huntington Hospital, Pasadena, California
| | - Maureen Dunn
- Department of Emergency Medicine, Huntington Hospital, Pasadena, California
| | - Paul Nieberg
- Department of Infectious Diseases, Huntington Hospital, Pasadena, California
| | - Jean Pallares
- Department of Pharmacy, Huntington Hospital, Pasadena, California
| | - Annie Wong-Beringer
- Department of Pharmacy, Huntington Hospital, Pasadena, California
- University of Southern California, School of Pharmacy, Los Angeles, California
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Gimbar RP, Rynn KO. Designing an emergency medicine pharmacy rotation. Am J Health Syst Pharm 2018; 75:602-605. [DOI: 10.2146/ajhp160896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Kevin O. Rynn
- University of Illinois at Chicago College of Pharmacy Rockford, IL
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18
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Sakeena MHF, Bennett AA, McLachlan AJ. Enhancing pharmacists' role in developing countries to overcome the challenge of antimicrobial resistance: a narrative review. Antimicrob Resist Infect Control 2018; 7:63. [PMID: 29744044 PMCID: PMC5930749 DOI: 10.1186/s13756-018-0351-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/03/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a global health challenge and developing countries are more vulnerable to the adverse health impacts of AMR. Health care workers including pharmacists can play a key role to support the appropriate use of antimicrobials in developing countries and reduce AMR. Objective The aim of this review is to investigate the role of pharmacists in the appropriate use of antibiotics and to identify how the pharmacists’ role can be enhanced to combat AMR in developing countries. Method The databases MEDLINE, EMBASE, Web of Science and Google Scholar were searched for articles published between 2000 and the end of August 2017 that involved studies on the role of pharmacists in developing countries, the expanded services of pharmacists in patient care in developed countries and pharmacists’ contributions in antimicrobial use in both developed and developing nations. Key findings In developing countries pharmacists role in patient care are relatively limited. However, in developed nations, the pharmacists’ role has expanded to provide multifaceted services in patient care resulting in improved health outcomes from clinical services and reduced health care costs. Success stories of pharmacist-led programs in combating AMR demonstrates that appropriately trained pharmacists can be part of the solution to overcome the global challenge of AMR. Pharmacists can provide education to patients enabling them to use antibiotics appropriately. They can also provide guidance to their healthcare colleagues on appropriate antibiotic prescribing. Conclusions This review highlights that appropriately trained pharmacists integrated into the health care system can make a significant impact in minimising inappropriate antibiotic use in developing countries. Strengthening and enhancing the pharmacists’ role in developing countries has the potential to positively impact the global issue of AMR.
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Affiliation(s)
- M H F Sakeena
- 1Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,2Sydney Pharmacy School, The University of Sydney, Sydney, NSW Australia
| | | | - Andrew J McLachlan
- 2Sydney Pharmacy School, The University of Sydney, Sydney, NSW Australia
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Urine culture guided antibiotic interventions: A pharmacist driven antimicrobial stewardship effort in the ED. Am J Emerg Med 2017; 35:594-598. [DOI: 10.1016/j.ajem.2016.12.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 11/19/2022] Open
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