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...
Autores principales: | , , |
---|---|
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 |
_version_ | 1784832842780377088 |
---|---|
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. |
format | Online Article Text |
id | pubmed-9672911 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT halcombsarahm impactofapharmacydepartmentwidetransitionsofcareprogramoninappropriateoralantibioticprescribingathospitaldischarge AT johnsonarianne impactofapharmacydepartmentwidetransitionsofcareprogramoninappropriateoralantibioticprescribingathospitaldischarge AT kangbirkenslena impactofapharmacydepartmentwidetransitionsofcareprogramoninappropriateoralantibioticprescribingathospitaldischarge |