Methods: We aimed to evaluate use of a post-graduate year one pharmacy resident to implement PAF at a 602-bed tertiary academic medical center. Monday through Friday mornings, a report was generated within the electronic health record (EHR) to identify patients on select antibiotics for ≥48 hours. The resident reviewed patients and made recommendations to the medical teams or clinical pharmacy specialists. Complicated patients were discussed with an infectious disease (ID) clinical pharmacy specialist.
Results: 227 patients were reviewed with the report identifying a mean (SD) 24 (±6.7) patients per day. Subsequently, ~20% of patients necessitated review with an ID clinical pharmacy specialist. Of all patients reviewed, 179 (79.2%) were intervened upon. Almost half (46.3%) of interventions were in patients with pneumonia or intra-abdominal infections. Ceftriaxone 49 (27.3%), intravenous vancomycin 35 (19.6%) and piperacillin-tazobactam 23 (12.8%) were intervened upon the most. Recommendations were primarily made to Medicine 74 (41.3%), Surgery 43 (24%), and Critical Care 26 (14.5%) services. Primary recommendations were duration of therapy or de-escalation for Medicine [36 (48.6%), 24 (32.4%)], Surgery, [24 (55.8%), 9 (20.9)], and Critical Care [7 (26.9%), 10 (38.4%)], respectively. ID was consulted on 35 (19.6%) patients with interventions. For select antimicrobials, days of therapy per 1000 patient days decreased from 733.1 to 669.4 from March 2017 to March 2018.
Conclusion: Non-ID trained clinical pharmacists or residents may perform PAF activities effectively. This informs potential PAF targets and may allow ASPs to reach more patients while optimizing escalation of complicated cases to an ID specialist.
K. Stewart, None
S. T. King, Melinta Therapeutics: Speaker's Bureau , Speaker honorarium .
J. Hand, None