1434. Impact of a Pharmacist-Driven Pneumonia Bundle in the Emergency Department (ED) of a Community Teaching Hospital
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Background: Antibiotic Stewardship teams are beginning to focus on a bundle approach to improve patient outcomes. This study was conducted to determine the impact of a pharmacist-driven pneumonia bundle (PB) in adult patients presenting to the ED with community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP).

Methods: Pharmacist prospectively intervened on pts from 2/1-3/31/15 with the defined diagnosis of pneumonia for PB components. PB included use of the pneumonia pathway, appropriate antibiotic (abx) administration within 8 hours,sputum collection within 8 hours of abx administration, abx de-escalation within 72 hours, and administration of influenza and pneumococcal immunizations. Completed components were scored 1 point each; max score 6. Control group received standard care.  Primary outcome was percent of patients with PB score ≥ 4. Secondary outcomes were abx de-escalation within 72 hours, length of stay (LOS), and 30-day readmission. Descriptive statistics were used to compare groups. Logistic regression was performed using SPSS (IBM) for PB score ≥4 with the variables pneumonia type, age, gender, time to antibiotics, COPD, time of day, and pharmacist intervention.

Results: 102 patients were included; 44 and 58 comprised the intervention (IG) and control group (CG), respectively. The average age was 69 and 73 years in the IG and CG groups.  Males represented 17/44 (38.6%) of the IG and 33/58 (56.9%) of CG.  HCAP and COPD was present 24/44 (54.5%) and 24/44 (54.5%) in the IG and 37/58 (63.8%) and 31/58 (53.4%) in the CG.  In the IG, 37/44 (84%) achieved a PB score ≥4 compared to 24/58 (41%) in the CG (p<0.05). Abx de-escalation at 72 hours occurred in 31/44 (70.5%) and 26/58 (44.8%) in the IG and CG.(p< 0.05).  Sputum was collected in 28/44 (63.6%) in the IG compared to 16/58 (27.6%) in the CG (p <0.05).  Average LOS was 6.98 days in the IG and 7.98 days in the CG (p=NS). 30 day readmission occurred in 9/44 (20.5%) in the IG and 14/58 (24.1%) in the CG (p=NS).  For the outcome of bundle score ≥4, pharmacist intervention and age > 65 were significant variables (p< 0.05).

Conclusion: Pharmacist intervention resulted in a significant increase in the obtainment of sputum cultures leading to subsequent abx de-escalation within 72 hours and improved adherence to the pneumonia bundle. Favorable trends were observed for LOS and 30 day readmission rate.

Christina Hanson, Pharm.D., Pharmacy, St. Joseph's Hospital Health Center, Syracuse, NY, Karen Whalen, BSPharm, BCPS, St. Joseph's Hospital, Syracuse, NY, Alecia Heh, Pharm.D. BCPS, St. Joseph's Hospital Health Center, Syracuse, NY and Lisa Avery, PharmD, BCPS, Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY

Disclosures:

C. Hanson, None

K. Whalen, None

A. Heh, None

L. Avery, None

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