Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge

OBJECTIVE: To evaluate oral antibiotic prescribing for common infections at hospital discharge before and after implementation of a pharmacist-driven transitions-of-care (TOC) program. DESIGN: Single-center before-and-after study. SETTING: Acute-care, academic, community hospital in Santa Barbara, C...

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Autores principales: Halcomb, Sarah M., Johnson, Arianne, Kang-Birken, S. Lena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672911/
https://www.ncbi.nlm.nih.gov/pubmed/36406165
http://dx.doi.org/10.1017/ash.2022.327
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author Halcomb, Sarah M.
Johnson, Arianne
Kang-Birken, S. Lena
author_facet Halcomb, Sarah M.
Johnson, Arianne
Kang-Birken, S. Lena
author_sort Halcomb, Sarah M.
collection PubMed
description OBJECTIVE: To evaluate oral antibiotic prescribing for common infections at hospital discharge before and after implementation of a pharmacist-driven transitions-of-care (TOC) program. DESIGN: Single-center before-and-after study. SETTING: Acute-care, academic, community hospital in Santa Barbara, California. PATIENTS: Eligible adult patients prescribed oral antibiotics at hospital discharge for community-acquired pneumonia, skin and soft-tissue infections, and urinary tract infections between September 2019 and December 2019 (preimplementation period) and between March 2021 and May 2021 (postimplementation period). INTERVENTION: Antimicrobial stewardship–initiated, department-wide, TOC program requiring all clinical pharmacists to review discharge antibiotic prescriptions in real time. RESULTS: In total, 260 antibiotic prescriptions were assessed for appropriateness: 140 before implementation and 120 after implementation. After implementation, the number of prescriptions considered inappropriate significantly decreased by 18% (52% vs 34%; P = .005). Inappropriate rates decreased in all assessment categories: dosing (15% vs 2%; P < .001), treatment duration (42% vs 31%; P = .08), antibiotic selection based on infection type or microbiology (8% vs 4%; P = .33), and antibiotics not indicated (16% vs 10%; P = .18). Median total antibiotic days decreased by 1 day after implementation (10 days vs 9 days; P = .67), and 30-day readmission rates were similar between both phases. CONCLUSIONS: A real-time, pharmacist-driven, TOC program for oral antibiotic prescriptions had a significant impact in reducing inappropriate prescribing of antibiotics at hospital discharge for common infections. Incorporating discharge antibiotic prescription review into pharmacist daily workflow may be a sustainable approach to outpatient antimicrobial stewardship in a setting with limited resources.
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spelling pubmed-96729112022-11-19 Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge Halcomb, Sarah M. Johnson, Arianne Kang-Birken, S. Lena Antimicrob Steward Healthc Epidemiol Original Article OBJECTIVE: To evaluate oral antibiotic prescribing for common infections at hospital discharge before and after implementation of a pharmacist-driven transitions-of-care (TOC) program. DESIGN: Single-center before-and-after study. SETTING: Acute-care, academic, community hospital in Santa Barbara, California. PATIENTS: Eligible adult patients prescribed oral antibiotics at hospital discharge for community-acquired pneumonia, skin and soft-tissue infections, and urinary tract infections between September 2019 and December 2019 (preimplementation period) and between March 2021 and May 2021 (postimplementation period). INTERVENTION: Antimicrobial stewardship–initiated, department-wide, TOC program requiring all clinical pharmacists to review discharge antibiotic prescriptions in real time. RESULTS: In total, 260 antibiotic prescriptions were assessed for appropriateness: 140 before implementation and 120 after implementation. After implementation, the number of prescriptions considered inappropriate significantly decreased by 18% (52% vs 34%; P = .005). Inappropriate rates decreased in all assessment categories: dosing (15% vs 2%; P < .001), treatment duration (42% vs 31%; P = .08), antibiotic selection based on infection type or microbiology (8% vs 4%; P = .33), and antibiotics not indicated (16% vs 10%; P = .18). Median total antibiotic days decreased by 1 day after implementation (10 days vs 9 days; P = .67), and 30-day readmission rates were similar between both phases. CONCLUSIONS: A real-time, pharmacist-driven, TOC program for oral antibiotic prescriptions had a significant impact in reducing inappropriate prescribing of antibiotics at hospital discharge for common infections. Incorporating discharge antibiotic prescription review into pharmacist daily workflow may be a sustainable approach to outpatient antimicrobial stewardship in a setting with limited resources. Cambridge University Press 2022-11-16 /pmc/articles/PMC9672911/ /pubmed/36406165 http://dx.doi.org/10.1017/ash.2022.327 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
spellingShingle Original Article
Halcomb, Sarah M.
Johnson, Arianne
Kang-Birken, S. Lena
Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge
title Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge
title_full Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge
title_fullStr Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge
title_full_unstemmed Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge
title_short Impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge
title_sort impact of a pharmacy department–wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672911/
https://www.ncbi.nlm.nih.gov/pubmed/36406165
http://dx.doi.org/10.1017/ash.2022.327
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