Effect of a pharmacist-managed culture review process on antimicrobial therapy in an emergency department.

PURPOSE. The impact of an emergency department (ED) procedure requiring pharmacist review of all culture results as a way to improve use of antimicrobial therapies was evaluated. METHODS. Rates of antimicrobial regimen modifications before and after implementation of a pharmacist-managed ED culture review procedure at Carolinas Medical Center-Northeast were determined through retrospective evaluation of medical records. To assess the potential impact of pharmacist-initiated antimicrobial regimen modifications on overall patient care, the frequency of ED readmissions within 96 hours of ED discharge and the reasons for those readmissions were evaluated. RESULTS. In the 12 months before implementation of the pharmacist-managed ED culture review process, the medical center's ED physicians reviewed 2278 culture reports and ordered antimicrobial regimen modifications in about 12% of cases; in about 19% of cases, patients were readmitted to the ED within 96 hours of discharge for treatment failure, patient noncompliance, allergy to medication, adverse drug reactions, and other reasons. In the 12 months after program implementation, pharmacists initiated antimicrobial regimen modifications in about 15% of cases; readmission to the ED occurred in about 7% of cases, with comparatively lower rates of readmission for treatment failure, noncompliance, and allergy to medication. CONCLUSION. ED pharmacists at Carolinas Medical Center-Northeast designed and implemented a pharmacist-managed culture review process. During a one-year period, ED pharmacists reviewed 2361 culture reports and modified the antimicrobial regimens of 355 patients.