Change in culture: Addition of a clinical pharmacist to the emergency department antimicrobial culture review process

Abstract

<p><strong>Objective:</strong> 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.</p> <p><strong>Setting:</strong> Academic-affiliated emergency department in Pittsburgh, Pennsylvania.</p> <p><strong>Methods:</strong> 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.&nbsp; 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 &ldquo;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&rdquo;.</p> <p><strong>Results:</strong> A Chi-Square Test of Independence was conducted to evaluate the relationship between two categorical variables:&nbsp; (1) type of provider (physician/pharmacists) and (2) adherence to clinical practice guidelines (yes/no).&nbsp; The test emerged significant,&nbsp;<em>C²</em>^&nbsp;= 17.4,&nbsp;<em>df</em>= 2,&nbsp;<em>p</em>&nbsp;&lt; 0.01.&nbsp; Thus, a significant relationship between type of provider and appropriate treatment was found.&nbsp; Specifically, 52.2% of physicians used the appropriate treatment whereas 84.4% of pharmacists used the appropriate treatment.</p>