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Enhancing Antimicrobial Therapy through a Pharmacist-Managed Culture Review Process in an Emergency Department Setting

Timothy C. Randolph, Pharm.D., Andrea Parker, Pharm.D., Liz Meyer, Pharm.D., Renee Zeina, Pharm.D.


Carolinas Medical Center - NorthEast, Concord, North Carolina

Emergency Department (ED) pharmacists were established at our institution in July 2007 for the purpose of medication reconciliation and prospective review of orders.  As these initial services were implemented, our team of ED pharmacists quickly realized a significant need for antimicrobial intervention and education.  Despite several educational activities, issues such as inappropriate antibiotic selection and inappropriate antibiotic dosing were not completely resolved.  Accordingly, the need for direct, prospective pharmacist involvement in our antimicrobial therapy process led to the design and implementation of our pharmacist-managed culture review process.

In order to establish the greatest potential for intervention, ED pharmacist involvement in antimicrobial therapy was carefully designed to focus on the review of any culture drawn in the ED, as well as on empiric antibiotic selection.  Our culture review process was designed and approved over the course of four months and went into practice on July 1, 2008.

Since the inception of this program, culture and susceptibility reports are delivered to the ED pharmacist every morning.  The ED pharmacist then compares patients’ prescribed empiric antimicrobial regimens to the culture and sensitivity data.  If patients are not receiving the appropriate antimicrobial therapy, the ED pharmacist consults with an ED physician and adjusts the regimen accordingly.  When required, a new prescription is called into the patient’s pharmacy.  Patients are then contacted and counseled by the ED pharmacist with regard to their culture results and prescribed antibiotics.  By speaking directly with these patients, our ED pharmacists are able to answer questions and counsel patients with regard to their antibiotic regimen and the importance of compliance.

In order to determine the impact of our pharmacist-managed culture review process on patient care, we compared one year of physician-managed cultures (June 30, 2007-June 30, 2008; n=2278) to one year of pharmacist-managed cultures (July 1, 2008-July 1, 2009; n=2361).  A total of 4,639 patient charts were reviewed.  The endpoints measured in each group included (1) number of antimicrobial regimens modified, (2) unplanned readmissions within 96 hours of initial culture review, and (3) reasons for unplanned readmission within 96 hours of culture review.

Our data indicates that pharmacists made more modifications to patients’ antimicrobial regimens and reduced the rate of unplanned readmissions due to treatment failure, non-compliance, and allergic reactions.  These observed differences were all statistically significant with p values < 0.05.  Based on the findings of this review, it is clear that the ED pharmacists at our institution have made a significant impact on patient care through the implementation of a pharmacist-managed culture review process.

Pharmacist-managed programs such as the program described here are important for the advancement of health-system pharmacy practice.  Innovative programs that directly involve health-system pharmacists will continue to advance the profession of pharmacy, and will undoubtedly have a tremendous impact on enhancing the care of our patients.

View a pdf of the poster from the Midyear Meeting (740 KB).