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Maleki S, Gu G, Buntine P, Zamani M, Zhu V, Chan K, Martin C, Goulopoulos A. The effect of an extended-hours ED clinical pharmacy service on admission medication prescribing errors. Emerg Med Australas 2024. [PMID: 38686457 DOI: 10.1111/1742-6723.14415] [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: 10/05/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this study was to determine the effect of a 7-day extended-hours clinical pharmacy service in the ED on medication prescribing errors upon hospital admission and time to medication reconciliation. METHODS In this retrospective observational study, high-needs patients reviewed by ED pharmacists were compared against those not reviewed, to determine if the service was associated with reduction in admission medication errors. The primary outcome was the rate of medication errors. Errors were independently rated by two senior clinicians using a risk-probability matrix. Secondary outcomes included service's impact on time to best possible medication history (BPMH) and medication reconciliation. RESULTS There were 242 patients who met the inclusion criteria: 105 intervention vs 137 control. In the intervention arm, 74 patients had at least 1 medication error compared with 113 in the control arm (total errors 206 vs 407). The error rate per 10 medications (interquartile range) was 1.4 (0, 2.9) in the intervention arm compared with 2.7 (1.2, 4.3) in the control arm (risk ratio 0.66 [95% confidence interval: 0.56-0.78]; P < 0.001). There were 33 moderate-risk and no high-risk errors (intervention), compared with 84 moderate-risk and 3 high-risk errors (control). Percent agreement was 98.98% (weighted kappa: 0.62). Time to BPMH and medication reconciliation were reduced from 40.5 and 45.0 h to 7.8 and 40.0 h, respectively. CONCLUSIONS The 7-day extended-hours ED clinical pharmacy service was associated with a reduction in medication prescribing errors in high-needs patients and improved time to BPMH and medication reconciliation.
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Affiliation(s)
- Sam Maleki
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Galahad Gu
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Paul Buntine
- Department of Emergency Medicine, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Mazdak Zamani
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Violet Zhu
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Kayin Chan
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne Goulopoulos
- Department of Pharmacy, Eastern Health, Box Hill, Victoria, Australia
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2
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Chase AM, Forehand CC, Keats KR, Taylor AN, Jones TW, Sikora A. Evaluation of Critical Care Pharmacist Evening Services at an Academic Medical Center. Hosp Pharm 2024; 59:228-233. [PMID: 38450349 PMCID: PMC10913874 DOI: 10.1177/00185787231207996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Purpose: Critical care pharmacists are considered essential members of the healthcare team; however, justification and recruitment of new positions, especially in the evening or weekend shifts, remains a significant challenge. The purpose of this study was to investigate the number of interventions, type of interventions, and associated cost savings with the addition of 1 board certified critical care clinical pharmacist to evening shift. Methods: This was a prospective collection and characterization of 1 evening shift critical care pharmacist's clinical interventions over a 12-week period. Interventions were collected and categorized daily from 13:00 to 22:00 Monday through Friday. After collection was complete, cost savings estimates were calculated using pharmacy wholesaler acquisition cost. Results: Interventions were collected on 52 of 60 weekdays. A total of 510 interventions were collected with an average of 9.8 interventions accepted per day. The most common interventions included transitions of care, medication dose adjustment, and antibiotic de-escalation and the highest proportion of interventions occurred in the medical intensive care unit. An estimated associated cost avoidance of $66 537.80 was calculated for an average of $1279.57 saved per day. Additionally, 22 (4.1%) of interventions were considered high yield interventions upon independent review by 2 pharmacists. Conclusion: The addition of 1 board-certified critical care pharmacist to evening shift resulted in multiple interventions across several categories and a significant cost avoidance when calculated using conservative measures.
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Affiliation(s)
- Aaron M. Chase
- Augusta University Medical Center, Augusta, GA, USA
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Christy C. Forehand
- Augusta University Medical Center, Augusta, GA, USA
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | | | | | - Timothy W. Jones
- Augusta University Medical Center, Augusta, GA, USA
- University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Andrea Sikora
- Augusta University Medical Center, Augusta, GA, USA
- University of Georgia College of Pharmacy, Augusta, GA, USA
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3
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Hardway J, Lucente FC, T Crawford A, Jarrouj A, Samanta D. Impact of the 24/7 nurse practitioner model on emergency department stay at a level 1 trauma center: A retrospective study. J Clin Nurs 2023; 32:517-522. [PMID: 35307879 DOI: 10.1111/jocn.16300] [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: 11/15/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 01/17/2023]
Abstract
AIMS The aim of the study was to assess the impact of 24/7 trauma nurse practitioner service model on the emergency department patient flow. BACKGROUND Seamless transition of trauma patients through the emergency department to inpatient hospital care is crucial for coordination of care, clinical safety and positive health outcomes. A level 1 trauma centre located in Southern West Virginia, USA expanded their trauma nurse practitioner service covering the emergency department 24/7. DESIGN Retrospective cohort study conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines. METHODS Patients admitted to the trauma centre between March 2019 and February 2020 were divided into two groups: trauma patients managed by trauma nurse practitioners versus the hospitalist service. The hospital service group was chosen as the comparator group because any admission prior to night coverage by the trauma nurse practitioners were managed by the hospitalist service. RESULTS The emergency department length of stay was significantly lower in trauma nurse practitioners' patients by an average of 300 min (772.25 ± 831.91 vs. 471.44 ± 336.65, p = <.001). Similarly, time to place emergency department discharge order was shorter by 49 min (277.76 ± 159.69 vs. 228.27 ± 116.04, p = .001) for this group. Moreover, trauma nurse practitioners on an average placed one less consultation (1.06 ± 0.23 vs. 1.46 ± 0.74, p < .001). CONCLUSION The patient care provided by trauma nurse practitioners aided in the reduction of strain felt by their emergency department. They were able to help facilitate patient flow thus lessening the pressure of boarding in an overcrowded emergency department. The study institution hopes to sustain the current service model and continue to review outcomes and processes managed by trauma nurse practitioners to ensure consistency and quality. RELEVANCE TO CLINICAL PRACTICE Similar trauma centres should evaluate the structure of their trauma service that includes the role of trauma nurse practitioner service and work towards allowing them to manage patient care from the emergency department 24/7.
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Affiliation(s)
- Jessica Hardway
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Frank C Lucente
- Charleston Area Medical Center, West Virginia University Physicians of Charleston, Charleston, West Virginia, USA
| | - Adam T Crawford
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Aous Jarrouj
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
| | - Damayanti Samanta
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
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4
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Falconer N, Snoswell C, Morris C, Barras M. The right time and place: the need for seven‐day pharmacist service models. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nazanin Falconer
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Centaine Snoswell
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
- Centre for Health Services Research Faculty of Medicine The University of Queensland The University of Queensland Brisbane Australia
| | - Christopher Morris
- Department of Internal Medicine Princess Alexandra Hospital Metro South Health Brisbane Australia
| | - Michael Barras
- School of Pharmacy Pharmacy Australia Centre of Excellence The University of Queensland Brisbane Australia
- Department of Pharmacy Princess Alexandra Hospital Metro South Health Brisbane Australia
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5
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Ng TM, Teo CJ, Heng ST, Chen YR, Lim WP, Teng CB. Impact of
round‐the‐clock
pharmacist inpatient medication chart review on medication errors. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tat Ming Ng
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Chong Junn Teo
- Department of Pharmacy, Faculty of Science National University of Singapore Singapore Singapore
| | - Shi Thong Heng
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Yi Rong Chen
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Wan Peng Lim
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
| | - Christine B Teng
- Department of Pharmacy Tan Tock Seng Hospital Singapore Singapore
- Department of Pharmacy, Faculty of Science National University of Singapore Singapore Singapore
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Welch S, Currey E, Doran E, Harding A, Roman C, Taylor S, Thomas A, Munro C. Standard of practice in emergency medicine for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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7
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Sin B, Ciaramella C, Stein G, Butel S, Thompson H, de Souza S, DiGregorio R. Implementation of an Advanced Pharmacy Practice Model in the Emergency Department. J Pharm Pract 2019; 33:481-490. [PMID: 30636511 DOI: 10.1177/0897190018819412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE The objective of this retrospective descriptive study was to quantify clinical activities performed by pharmacists in an advanced pharmacy practice model in the emergency department (ED). METHODS Data from January 2015 to August 2017 extracted from the department of pharmacy's electronic documentation system and the hospital's electronic medical record were collected and reviewed. Cost savings was derived from the system with adaptation from the previous literature and had been validated by our institution's administration as an acceptable reflection of the impact for activity. RESULTS The ED pharmacy team participated in a total of 4106 clinical activities that resulted in a cumulative cost avoidance of $5 387 679. Overall, the most common clinical activities that the pharmacy team provided included pharmacotherapy consult (63.3%) and response to medical emergencies (20.7%). A total of 16 219 medication orders placed by ED clinicians were prospectively reviewed and 379 interventions were accepted by ED clinicians. Turnaround times for medication verification in median (interquartile range [IQR]) for 2015, 2016, and 2017 were 2 minutes (1-6 minutes), 3 minutes (1-6 minutes), and 2 minutes (1-5 minutes), respectively. A total of 14 peer-reviewed publications, primarily based on pharmacy practice or use of pharmacotherapy for acute pain, were published by a research program led by the ED pharmacotherapist. CONCLUSION We created and implemented an advanced practice model tailored to our institution's needs. The model maximized opportunities for pharmacists to provide direct patient care, practice at the top of their license, and encouraged the safe and effective use of medications.
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Affiliation(s)
- Billy Sin
- Mount Sinai Queens, Long Island City, NY, USA
| | - Christine Ciaramella
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Greg Stein
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Shalom Butel
- Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Holly Thompson
- Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sylvie de Souza
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.,Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Robert DiGregorio
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.,Department of Clinical Affairs, Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
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8
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Farmer BM, Hayes BD, Rao R, Farrell N, Nelson L. The Role of Clinical Pharmacists in the Emergency Department. J Med Toxicol 2018; 14:114-116. [PMID: 29075954 PMCID: PMC6013729 DOI: 10.1007/s13181-017-0634-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Brenna M Farmer
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Rama Rao
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Manias E. Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review. Expert Opin Drug Saf 2018; 17:259-275. [PMID: 29303376 DOI: 10.1080/14740338.2018.1424830] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Medication errors are commonly affected by breakdowns in communication. Interdisciplinary collaboration is an important means of facilitating communication between health professionals in clinical practice. To date, there has been little systematic examination of past research in this area. AREAS COVERED The aims of this integrative review are to examine how interdisciplinary collaboration influences medication errors in hospitals, the araes of interdisciplinary collaboration that have been researched in previous work, and recommendations for future research and practice. An integrative review was undertaken of research papers (N = 30) published from inception to August 2017 using MEDLINE, the Cochrane Library, CINAHL, PsycINFO, and Embase. EXPERT OPINION Five different areas of interdisciplinary collaboration were identified in research involving medication errors. These areas were: communication through tools including guidelines, protocols, and communication logs; participation of pharmacists in interdisciplinary teams; collaborative medication review on admission and at discharge; collaborative workshops and conferences; and complexity of role differentiation and environment. Despite encouraging results demonstrated in past research, medication errors continued to occur. Increased focus is needed on developing tailored, individualized strategies that can be applied in particular contexts to create further reductions in medication errors. Greater understandings are also needed about the changing roles of various disciplines.
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Affiliation(s)
- Elizabeth Manias
- a Faculty of Health, School of Nursing and Midwifery , Deakin University , Burwood , Australia.,b The Royal Melbourne Hospital, Department of Medicine , The University of Melbourne , Parkville , Australia.,c Department of Nursing, School of Health Sciences , The University of Melbourne , Parkville , Australia
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10
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Sin B, Lau K, Tong R, Ruiz J, Sarosky K, DiGregorio R, Butel S, de Souza S. The Feasibility and Impact of Prospective Medication Review in the Emergency Department. J Pharm Pract 2017; 31:22-28. [PMID: 28430007 DOI: 10.1177/0897190017696948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We evaluated the feasibility and impact of prospective medication review (PMR) in the emergency department (ED). METHODS This was a retrospective cohort study of all nonadmitted ED patients who were prescribed medication orders by ED clinicians from September 2014 to September 2015 to determine the time intervals utilized during each step of the medication use process and quantify the number of interventions conducted by the pharmacist and cost avoidance accrued from the interventions. RESULTS A total of 834 medication orders were included for evaluation. The median time for order verification, order verification to dispense, and dispense to administration were 3 minutes (interquartile range [IQR] = 1-7 minutes), 20 minutes (IQR = 7-45 minutes), and 10 minutes (IQR = 6-16 minutes). The median time interval for order verification was longer during the overnight pharmacy shift (median = 5 minutes, IQR = 2-9 minutes) compared to the day and evening shifts (median = 3 minutes, IQR = 1-6 minutes). A total of 563 interventions were recommended by the pharmacists and accepted by ED clinicians. These interventions equated to US$47 585 worth of cost avoidance. CONCLUSION The PMR is a feasible process that resulted in safe and effective use of medications without causing delays to patient care.
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Affiliation(s)
- Billy Sin
- 1 Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA.,2 Division of Pharmacotherapy Services, Department of Pharmacy, Emergency Department Clinical Research Program, Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Kwong Lau
- 1 Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
| | - Richard Tong
- 1 Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
| | - Josel Ruiz
- 3 Emergency Medicine Clinical Research Program, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Kimberly Sarosky
- 4 Emergency Medicine-Critical Care, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Robert DiGregorio
- 1 Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA.,5 Department of Pharmacy, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Shalom Butel
- 6 Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sylvie de Souza
- 6 Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
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Hunt A, Nakajima S, Hall Zimmerman L, Patel M. Impact of prospective verification of intravenous antibiotics in an ED. Am J Emerg Med 2016; 34:2392-2396. [PMID: 27641249 DOI: 10.1016/j.ajem.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/03/2016] [Accepted: 09/05/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED. METHODS This retrospective, institutional review board-approved preimplementation vs postimplementation study evaluated patients 18years or older who were started on IV antibiotics in the ED. Patients were excluded if pregnant, if the patient is a prisoner, if no cultures were drawn, or if the patient was transferred from an outside facility. Appropriate antibiotic therapy was based on empiric source-specific evidence-based guidelines, appropriate pharmacokinetic and pharmacodynamic properties, and microbiologic data. The primary end point was the time from ED arrival to administration of appropriate antibiotic therapy. RESULTS Of the 1628 evaluated, 128 patients met the inclusion criteria (64 pre vs 64 post). Patients were aged 65.2±17.0years, with most of infections being pneumonia (44%) and urinary tract infections (18%) and most patients being noncritically ill. Time to appropriate antibiotic therapy was reduced in the postgroup vs pregroup (8.1±8.6 vs 15.2±22.8hours, respectively, P=.03). In addition, appropriate empiric antibiotics were initiated more frequently after the implementation (92% post vs 66% pre; P=.0001). There was no difference in mortality or length of stay between the 2 groups. CONCLUSION Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of antibiotics by pharmacists led to significant improvement on both empiric selection of and time to appropriate antibiotic therapy.
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Affiliation(s)
- Allyson Hunt
- Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC.
| | - Steven Nakajima
- Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC.
| | - Lisa Hall Zimmerman
- Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC.
| | - Manav Patel
- Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC.
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