Methods: This was a retrospective chart review of a convenience sample of patients reviewed by the AMS service from September 2012 to March 2015 at a 119-bed Veterans Affairs Medical Center. As part of prospective audit and feedback of all patients on antibiotics admitted to the medical center, a pharmacist and physician trained in Infectious Diseases reviewed antibiotic selection, dose, duration, route, and indication. Recommendations were then communicated to the prescriber verbally (telephone or in-person) and/or entered as notes into the patient’s EMR, then forwarded to the physician responsible for the patient’s care. Variables collected included intervention type (i.e. dose and/or drug change, antibiotic discontinuation, etc.), communication method, acceptance status (considered accepted if recommendation implemented), and reason for rejection if the recommendation was not accepted. Differences in verbal and electronic recommendation acceptance rates were assessed using X2.
Results: We reviewed 1,397 cases, making interventions on 635 (45.5%), with a 71.3% acceptance rate. These interventions accounted for 52% of all interventions since the inception of the AMS program. There were 444 (69.9%) EMR note and 191 (30.1%) verbal recommendations. Verbal recommendation acceptance was higher than the acceptance rate for EMR notes (85.3% vs 65.3%, p < 0.0001). The most common reasons EMR note and verbal recommendations were not accepted were lack of prescriber acknowledgement (22%) and wishing to keep the current antibiotic regimen (29%), respectively.
Conclusion: Verbal communication with the prescribing physician was more effective in the implementation of AMS interventions. Verbal recommendations may be the preferred method of communication to ensure all interventions are received by the prescriber responsible for the patient’s antimicrobial regimen.
D. Parente, None
H. Morrill, None
M. Gaitanis, None
K. Laplante, Cubist Pharmaceuticals: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Pfizer Pharmaceuticals: Grant Investigator , Grant recipient
Theravance Biopharma: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient
Durata: Scientific Advisor , Consulting fee
Forest Laboratories: Scientific Advisor , Consulting fee
Marvao: Grant Investigator , Grant recipient
Melinta: Scientific Advisor , Consulting fee
Davol: Scientific Advisor , Consulting fee
Theradoc: Scientific Advisor , Consulting fee