title: Impact of an emergency medicine pharmacist on antibiotic dosing adjustment.
abstract: OBJECTIVE
  Overall medication-related errors in the emergency department (ED) are 13.5 times more likely to occur in the absence of an emergency medicine pharmacist (EMP). Although the effectiveness of pharmacist-driven renal dosing adjustment has been studied in the intensive care unit, data are lacking in the ED setting. The aim of our study was to evaluate the appropriateness of antibiotic dosing when an EMP is physically present in the ED compared to when absent.
  
  
  METHODS
  This was a retrospective cohort study of patients treated in a level I trauma center with 75 adult and 12 pediatric beds and an annual census of 90000 patients. The study period was from March 1 to September 30, 2014. An EMP was physically present in the ED from 11:00 to 01:30 and absent from 01:31 to 10:59. Male and female patients 18years and older were considered for inclusion if cefazolin, cefepime, ciprofloxacin, piperacillin-tazobactam, or vancomycin was ordered. The primary outcome was the composite rate of correct antibiotic dose and frequency. Statistics included a multivariable logistic regression using age, sex, presence of EMP, and creatinine clearance as independent predictors of correct antibiotic use.
  
  
  RESULTS
  A total 210 cases were randomly chosen for evaluation, half during times when EMPs were present and half when they were absent. There were 130 males (62%) with an overall mean age of 54±18years. Overall, 178 (85%) of 210 of the antibiotic orders were appropriate, with 95% appropriate when an EMP was present compared to 74% when an EMP was absent (odds ratio, 6.9; 95% confidence interval, 2.5-18.8). In a logistic regression model, antibiotic appropriateness was independently associated with the presence of the EMP and creatinine clearance.
  
  
  CONCLUSIONS
  Antibiotics that require renal and/or weight dosing adjustment are 6.5 times more likely to be appropriate in the ED when an EMP is present. Prevalence of antibiotic dosing error is related to both the presence of EMPs and the degree of renal impairment.
authors.affiliation: Departments of Pharmacy, University of New, Mexico, Albuquerque, NM.
authors.forename: Kyle M
authors.initials: KM
authors.lastname: DeWitt
authors.affiliation: Department of Emergency Medicine, University of New, Mexico, Albuquerque, NM.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Weiss
authors.affiliation: Departments of Pharmacy, University of New, Mexico, Albuquerque, NM.
authors.forename: Shannon
authors.initials: S
authors.lastname: Rankin
authors.affiliation: Department of Emergency Medicine, University of New, Mexico, Albuquerque, NM.
authors.forename: Amy
authors.initials: A
authors.lastname: Ernst
authors.affiliation: Departments of Pharmacy, University of New, Mexico, Albuquerque, NM.
authors.forename: Preeyaporn
authors.initials: P
authors.lastname: Sarangarm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D010607:Pharmacy Service, Hospital; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents