Program Schedule

Evaluation of Antimicrobial Stewardship in an Academic Medical Center Emergency Department (ED)

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IDSA 2014_ED cx review poster_Anthone_09.24.14.pdf (1.0 MB)
  • Background: Current available literature supports the importance of timely follow-up and appropriate antimicrobial selection for discharged patients from the ED.  We sought to evaluate the impact of implementing a pharmacist-managed antimicrobial stewardship program (ASP) in our hospital’s ED by assessing measurable outcomes related to patient follow-up.

    Methods: This quality assurance project included all patients with positive culture results after being discharged home from the ED.  The culture review process included screening the daily laboratory patient report for positive results, collecting pertinent data, and determining if empiric therapy at discharge from ED was appropriate based on current evidence-based practice guidelines.  If lab result was positive for a sexually transmitted disease (STD) or empiric therapy inappropriate, an attempt was made to contact the patient and/or PCP by phone.  If available, notified of test result(s) and called in new prescription when indicated.  If unavailable, letter was sent to the patient’s stated home address.  The control group (6 weeks) assessed the current practice of ED Physician Assistant (PA) culture follow-up and the intervention group (15 weeks) assessed the transition to ASP-pharmacist management.  Data was collected retrospectively for the control phase and prospectively during the intervention period.  This project was IRB approved and data was analyzed using SPSS-PC (ver. 21).

    Results: During the intervention phase, attempted patient and/or PCP follow-up occurred in 72/73 (98.7%) cases versus 10/22 (45.5%) in the control group (p < 0.001).  No differences in percentage of inappropriate empiric prescribing were seen (44.9% vs 41.2%, p > 0.05).  Comparing control versus intervention group, STD and urinary tract infection (UTI) accounted for the majority of mistreated infections.  Of the reasons for inappropriate empiric therapy, no treatment prescribed and drug-bug mismatch were the most common.  In addition, a sub group analysis of STD treatment in ED patients revealed deficiencies in provider prescribing practices and as a result education was provided. 

    Conclusion: Implementation of an ASP in the ED can improve timeliness of culture review and provide more consistent patient follow-up while reducing the non-clinical workload of ED providers.

    Jennifer Anthone, PharmD1,2, Barry Nakaoka, PharmD1, Renuga Vivekanandan, MD1,2, Krysta Baack, PharmD1, John Horne, MD1,2 and Tammy Burns, PharmD2, (1)Alegent Creighton Health - Creighton University Medical Center, Omaha, NE, (2)Medicine, Creighton University School of Medicine, Omaha, NE


    J. Anthone, None

    B. Nakaoka, None

    R. Vivekanandan, None

    K. Baack, None

    J. Horne, None

    T. Burns, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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