Change in culture: Addition of a clinical pharmacist to the emergency department antimicrobial culture review process
Samantha Streiff, DNP(c), RN; Denise Ramponi, DNP, FNP-C, ENP-BC, FAANP, FAEN; Thomas W. Cline, MBA, Ph.D.
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Objective: To evaluate the effectiveness of a unit based pharmacist in assisting with antimicrobial selection of female patients discharged from the emergency department with a diagnosis of an uncomplicated urinary tract infection.
Setting: Academic-affiliated emergency department in Pittsburgh, Pennsylvania.
Methods: A retrospective chart review was conducted among 870 female patients who were discharged from the emergency department with a positive urine culture requiring antimicrobial therapy revision. The primary investigator abstracted specific medical record information to determine if a pharmacist-driven culture review resulted in a higher percentage of appropriate antimicrobial selection when compared to the standard nurse/physician driven-culture review. The revised antimicrobial therapy treatment plan was deemed appropriate or not based on the “International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Disease Society of American and the European Society for Microbiology and Infectious Disease”.
Results: A Chi-Square Test of Independence was conducted to evaluate the relationship between two categorical variables: (1) type of provider (physician/pharmacists) and (2) adherence to clinical practice guidelines (yes/no). The test emerged significant, C2 = 17.4, df= 2, p < 0.01. Thus, a significant relationship between type of provider and appropriate treatment was found. Specifically, 52.2% of physicians used the appropriate treatment whereas 84.4% of pharmacists used the appropriate treatment.
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
|Type||DNP Capstone Project|
|Review Type||Faculty Approved: Degree-based Submission|
|Evidence Level||Clinical Practice Guideline(s)|
|Research Approach||Qualitative Research|
|CINAHL Subject(s)||Emergency Service;
Antiinfective Agents--Therapeutic Use;
|MESH Subject(s)||Emergency Services, Hospital|
|MESH Subject(s)||Emergency Services, Hospital|
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