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Team of Pharmacists Focuses on Antimicrobial Therapy

Jan 21, 2010

THE RISING PREVALENCE across the country of infectious diseases in patients who visit emergency departments (EDs) remains one of the biggest challenges being faced by health care personnel today.

The pharmacy team at Carolinas Medical Center-NorthEast won a 2009 ASHP Best Practices Award for its work overseeing patients’ antibiotic regimens.

In this busy environment, pharmacists often must play the role of interventionist to help guide physicians toward appropriate antibiotic selection and dosage to address resistant infections and tailor therapy to local resistance patterns. A team of pharmacists at Carolinas Medical Center-NorthEast, in Concord, N.C., is helping to shift this paradigm. Timothy C. Randolph, Pharm.D.; Andrea Parker, Pharm.D.; Liz Meyer, Pharm.D.; and Renee Zeina, Pharm.D., have moved beyond a consultation role into one of helping to oversee patients’ antibiotic regimens.

“Our team is doing a lot to open the eyes of physicians to show what pharmacists can bring to the ER,” said Randolph, who helped kick off the program in partnership with Mary Anne Nolan, R.N., M.S.N., and Andrew Matthews, M.D.

Dramatic Reductions in Hospital Readmissions

Since June 2008, the team has managed the ED culture review process. When cultures are drawn, the pharmacist on duty helps select empiric antimicrobial therapy. Once culture and sensitivity data is finalized, the ED pharmacist de-escalates the medication regimen.

The results of this shift in responsibilities have been stunning: Not only have the ED pharmacists dramatically cut the number of unplanned readmissions, but they have also saved the ED physicians approximately 50 hours of work each month.

The team’s work is so impressive that it garnered a 2009 ASHP Best Practices Award in Health-System Pharmacy, an award that honors outstanding practitioners who have successfully implemented systems to improve patient care.

The pharmacy team’s submission described the results of a retrospective study conducted to measure the impact that this pharmacist-managed culture review process has had on patient outcomes.

The study of more than 4,600 patient charts measured two primary outcomes—the number of antimicrobial regimens modified and unplanned readmission rates— following culture review. The team then compared data from 12 months of physician-managed culture review against data from 12 months of pharmacist-managed culture review.

A “Win-Win Situation”

The results showed that the pharmacist-managed program resulted in a 3 percent increase in modifications made to patients’ antimicrobial regimens and a 12 percent reduction in the number of unplanned readmissions to the ED occurring within 96 hours of patients’ initial discharge.

“If we can prove that we can prevent a significant number of readmissions, patients will benefit, and the hospital will save money,” Randolph said. “It’s a win-win situation.”

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