State University of New York Upstate University Hospital, Syracuse, NY, USA.
State University of New York Upstate Medical University, Syracuse, NY, USA.
Ann Pharmacother. 2022 Aug;56(8):869-877. doi: 10.1177/10600280211052677. Epub 2021 Nov 5.
Approximately 30% of antimicrobials prescribed in the outpatient setting are unnecessary and up to 50% are inappropriate. Despite this, antimicrobial stewardship (AS) efforts mostly focus on the inpatient setting, and limited data describe AS interventions at hospital discharge. Acknowledging the potential value of discharge AS, we used our existing resources to review discharge oral antimicrobial prescriptions.
The primary objective of this retrospective, single-center study was to evaluate the impact of an AS program on discharge oral antimicrobial prescriptions.
Discharge oral antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy, reviewed by an infectious diseases (ID) pharmacist, and recorded into our data collection tool from September 1, 2020, to February 28, 2021, were evaluated retrospectively. The primary outcome was to identify the frequency a drug-related problem (DRP) was identified by an ID pharmacist. Secondary outcomes included DRP characterization, percentage of prescriptions with interventions, intervention acceptance rate, and reduction in antimicrobial days dispensed at discharge when interventions to limit treatment duration were accepted.
Of the 803 discharge oral antimicrobial prescriptions reviewed, at least 1 DRP was identified in 43.1% (346/803). The most frequently identified DRPs pertained to treatment duration, drug selection, and dose selection. At least 1 intervention was recommended in 42.8% (344/803) of prescriptions. In total, 438 interventions were made and the acceptance rate was 75.6% (331/438). The most common types of interventions included recommendations for a different duration, a different dose or frequency, and antimicrobial discontinuation. When interventions to reduce treatment duration were accepted, the median (interquartile range) number of antimicrobial days decreased from 8 (5-10) days to 4 (0-5.5) days ( < 0.001).
An ID pharmacist's review of discharge oral antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy resulted in identification of DRPs and subsequent interventions in a substantial number of prescriptions.
约 30%的门诊处方抗生素是不必要的，多达 50%的处方是不适当的。尽管如此，抗菌药物管理（AS）工作主要集中在住院环境中，并且只有有限的数据描述了出院时的 AS 干预措施。鉴于出院 AS 的潜在价值，我们利用现有资源审查出院口服抗生素处方。
本回顾性单中心研究的主要目的是评估 AS 计划对出院口服抗生素处方的影响。
我们回顾性评估了 2020 年 9 月 1 日至 2021 年 2 月 28 日期间，送到我们医院运营的门诊药房、由传染病（ID）药剂师审查并记录到我们的数据收集工具中的出院口服抗生素处方。主要结果是确定 ID 药剂师发现药物相关问题（DRP）的频率。次要结果包括 DRP 特征、有干预措施的处方比例、干预接受率以及当接受限制治疗持续时间的干预措施时，出院时的抗生素天数减少。
在 803 份出院口服抗生素处方中，至少有 1 个 DRP 被发现占 43.1%（346/803）。最常出现的 DRP 涉及治疗持续时间、药物选择和剂量选择。至少有 1 项干预措施被推荐占 42.8%（344/803）的处方。共提出 438 项干预措施，接受率为 75.6%（331/438）。最常见的干预类型包括建议不同的持续时间、不同的剂量或频率以及抗生素停药。当接受减少治疗持续时间的干预措施时，中位数（四分位距）的抗生素天数从 8（5-10）天减少到 4（0-5.5）天（<0.001）。
ID 药剂师对送到我们医院运营的门诊药房的出院口服抗生素处方进行审查，结果在大量处方中发现了 DRP 并随后进行了干预。
