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.
A. Heh, None
L. Avery, None