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Analysis

Emergency Medicine Pharmacists Boost Antibiotics Stewardship

By Christopher Cheney  
   June 21, 2019

Emergency medicine pharmacists increase guideline-concordant prescribing at hospitals with both new and established antibiotic stewardship programs.

Employing emergency medicine pharmacists improves empiric antibiotic prescribing for pneumonia and intra-abdominal infections, recent research shows.

Appropriate prescribing of antibiotics is essential to help avoid the development of antibiotic-resistant infections, which the Centers for Disease Control and Prevention calls one of the most severe public health problems in the country. Antibiotics also have been linked to negative patient impacts such as Clostridium difficile infections.

The recent research published in the American Journal of Emergency Medicine found that employing emergency medicine pharmacists (EMPs) not only boosted guideline-concordant empiric antibiotic prescribing but also increased the likelihood that appropriate therapy would be ordered after patients were admitted for hospitalization.

The research, which featured 185 patients treated when EMPs were present and 135 patients treated when EMPs were not present, generated several key results:

  • The overall likelihood of empiric antibiotic prescribing was higher when an EMP was present than when an EMP was not present: 78% vs. 61%.
     
  • For community-acquired pneumonia, the rate of guideline-concordant prescribing was 95% when an EMP was present compared to 79% when an EMP was absent.
     
  • For community-acquired intra-abdominal infections, the rate of guideline-concordant prescribing was 62% when an EMP was present compared to 44% when an EMP was absent.
     
  • More than 80% of patients who received guideline-concordant antibiotics in the emergency room continued to receive appropriate therapy after hospital admission, compared to only 18.8% of admitted patients who received inappropriate therapy in the ER.
     
  • The presence of an EMP improved empiric antibiotic prescribing for hospitals with both new and established antimicrobial stewardship programs (ASPs).

"This study shows the importance of coupling ED clinical pharmacist activities with ASP initiatives. Total guideline-concordant prescribing significantly increased over time, with improved prescribing adherence demonstrated in both the early-ASP and established-ASP groups when an EMP was present," the researchers wrote.

EMPs can play a unique role in boosting guideline-concordant prescribing, the researchers found. "EMPs are in an ideal position to encourage appropriate empiric prescribing as they can make real-time recommendations for antibiotic selection or intervene and suggest alternatives when inappropriate antibiotics are ordered."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Inappropriate antibiotics prescribing increases antibiotic-resistant infections and can have negative patient impacts such as Clostridium difficile infections.

Researchers found that the overall likelihood of empiric antibiotic prescribing was 17 percentage points higher when an emergency medicine pharmacist was present than when an EMP was not present.

Emergency medicine pharmacists can make real-time recommendations for antibiotic selection or suggest options when inappropriate antibiotics are ordered.


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