ED pharmacist monitoring of provider antibiotic selection aids appropriate treatment for outpatient UTI.
OBJECTIVE
We sought to determine whether an emergency department (ED) pharmacist could aid in the monitoring and correction of inappropriate empiric antibiotic selection for urinary tract infections in an outpatient ED population.


METHODS
Urine cultures with greater than 100 000 CFU/mL bacteria from the University of Utah Emergency Department over 1 year (October 2011-Sept 2012) were identified using our electronic medical record system. Per ED protocol, an ED pharmacist reviews all cultures and performs a chart review of patient symptoms, diagnosis, and discharge antibiotics to determine whether the treatment was appropriate. A retrospective review of this process was performed to identify how often inappropriate treatment was recognized and intervened on by an ED pharmacist.


RESULTS
Of the 180 cultures included, a total of 42 (23%) of empiric discharge treatments were considered inappropriate and required intervention. In 35 (83%) of 42 patients, the ED pharmacist was able to contact the patient and make appropriate changes; the remaining 7 patients were unable to be contacted, and no change could be made in their treatment.


CONCLUSIONS
A chart review of all urine cultures with greater than 100 000 CFU/mL performed by an ED pharmacist helped identify inappropriate treatment in 23% of patients discharged to home with the diagnosis of urinary tract infection. Of these patients who had received inappropriate treatment, an ED pharmacist was able to intervene in 83% of cases. These data highlight the role of ED pharmacists in improving patient care after discharge.
Inpatient Pharmacy Services, University of Utah, Salt Lake City, UT, USA.
Erin
E
Lingenfelter
Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
Zachary
Z
Drapkin
Inpatient Pharmacy Services, University of Utah, Salt Lake City, UT, USA.
Kelly
K
Fritz
Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
Scott
S
Youngquist
Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
Troy
T
Madsen
Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
Megan
M
Fix
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010595:Pharmacists; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy*; D055815:Young Adult
D000900:Anti-Bacterial Agents