Cornell W Kyle, Hile Garrett, Stone Tyler, Hannum Jennifer, Reichert Marc, Hollinger Meredith K
Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
University of Kentucky Healthcare, Lexington, KY, USA.
Am J Health Syst Pharm. 2022 Nov 22;79(Suppl 4):S106-S114. doi: 10.1093/ajhp/zxac157.
Culture response programs are an important antimicrobial stewardship strategy in the emergency department. Pharmacists often have a key role in culture response but are most often dependent on other providers to optimize a patient's antimicrobial therapy. This study assessed the impact of advanced practice pharmacists, with independent prescribing authority, on an emergency department culture response program.
This was a quasi-experimental preimplementation vs postimplementation evaluation performed at an academic medical center, with a 91-bed adult and pediatric emergency department, during the transition from a nurse-driven to an advanced practice pharmacist-driven program. The primary endpoint was time elapsed between initial culture review and intervention.
Data on 200 interventions were collected from both the pre- and postimplementation phases. Median time from culture review to intervention was 5.27 hours (interquartile range [IQR], 2.8-24.2 hours) before implementation, compared to 2.95 hours (IQR, 1.4-6.1) after implementation (P < 0.001). The nurse-driven program intervened on 27% of positive cultures, while pharmacists intervened on 42% of positive cultures. The types of interventions performed and antibiotic prescribing patterns differed between the 2 study phases, but all choices were deemed appropriate by the criteria set for the purposes of this study.
The roles of advanced practice pharmacists allowed for the establishment of a streamlined culture response workflow. Culture responses occurred at a faster rate than with the previous nurse-driven program while maintaining high-quality clinical decision-making.
培养应对计划是急诊科一项重要的抗菌药物管理策略。药剂师在培养应对中通常起着关键作用，但大多依赖其他医疗服务提供者来优化患者的抗菌治疗。本研究评估了具有独立处方权的高级执业药剂师对急诊科培养应对计划的影响。
这是一项在一家学术医疗中心进行的准实验性实施前与实施后评估，该中心有一个拥有91张床位的成人及儿科急诊科，处于从护士主导计划向高级执业药剂师主导计划的过渡阶段。主要终点是从初次培养检查到干预的时间间隔。
从实施前和实施后阶段收集了200次干预的数据。实施前，从培养检查到干预的中位时间为5.27小时（四分位间距[IQR]，2.8 - 24.2小时），实施后为2.95小时（IQR，1.4 - 6.1）（P < 0.001）。护士主导的计划对27%的阳性培养结果进行了干预，而药剂师对42%的阳性培养结果进行了干预。两个研究阶段进行的干预类型和抗生素处方模式有所不同，但根据本研究设定的标准，所有选择都被认为是合适的。
高级执业药剂师的角色使得能够建立简化的培养应对工作流程。培养应对的速度比之前护士主导的计划更快，同时保持了高质量的临床决策。
