title: Pharmacist addition to the post-ED visit review of discharge antimicrobial regimens.
abstract: OBJECTIVE
  Our objective was to evaluate whether pharmacist addition to the postvisit review of discharged adult emergency department (ED) visits' prescriptions/cultures would reduce the prevalence of revised antimicrobial regimen inappropriateness.
  
  
  METHODS
  We conducted a retrospective observational study of discharged adult ED visits to a single center with positive cultures requiring antimicrobial regimen revision (May 1 to October 31, 2012, nurse process; February 1 to July 31, 2013, nurse/pharmacist process). Investigators abstracted cohorts' medical records for demographic, ED diagnosis, original/revised antibiotic regimen, culture result, medical history, medications, and patient instruction data and determined whether the revised regimen was inappropriate based on Infectious Diseases Society of America/Centers for Disease Control and Prevention and clinical guidelines. We used the large sample z-test to compare the prevalence of revised antimicrobial regimen inappropriateness between the 2 cohorts.
  
  
  RESULTS
  In the prepharmacist cohort, there were 411 positive ED discharge cultures. Seventy-three (17.8%; 95% confidence interval [CI], 14.1%-21.5%) required antimicrobial regimen revision; 34 of these met 1 or more level of inappropriateness (46.6%; 95% CI, 35.1%-58.0%). In the postpharmacist cohort, there were 459 positive ED discharge cultures. Seventy-five (16.3%; 95% CI, 13.0%-19.7%) required revision; 11 of these met 1 or more level of inappropriateness (14.7%; 95% CI, 6.7%-22.7%; z = 4.2; P < .0001 for comparison).
  
  
  CONCLUSIONS
  In this single-center study, pharmacist addition to the postvisit review of discharged adult ED patients' prescriptions/cultures reduced the prevalence of revised antimicrobial regimen inappropriateness.
authors.affiliation: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Miller
authors.affiliation: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USA.
authors.forename: Molly A
authors.initials: MA
authors.lastname: McGraw
authors.affiliation: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Tomsey
authors.affiliation: Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Gajanan G
authors.initials: GG
authors.lastname: Hegde
authors.affiliation: Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shang
authors.affiliation: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: O'Neill
authors.affiliation: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA. Electronic address: avenkat@wpahs.org.
authors.forename: Arvind
authors.initials: A
authors.lastname: Venkat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004635:Emergency Medicine / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007239:Infections / Q000188:drug therapy*; D008297:Male; D008826:Microbial Sensitivity Tests; D008828:Microbiological Techniques; D008875:Middle Aged; D010351:Patient Discharge; D010604:Pharmacy / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents