Document Type
Article
Publication Title
Antimicrobial Stewardship and Healthcare Epidemiology
Department
Pharmacy
ISSN
2732494X
Volume
2
Issue
1
DOI
10.1017/ash.2022.327
First Page
1
Last Page
6
Publication Date
11-16-2022
Abstract
Objective: To evaluate oral antibiotic prescribing for common infections at hospital discharge before and after implementation of a pharmacist-driven transitions-of-care (TOC) program. Design: Single-center before-and-after study. Setting: Acute-care, academic, community hospital in Santa Barbara, California. Patients: Eligible adult patients prescribed oral antibiotics at hospital discharge for community-acquired pneumonia, skin and soft-tissue infections, and urinary tract infections between September 2019 and December 2019 (preimplementation period) and between March 2021 and May 2021 (postimplementation period). Intervention: Antimicrobial stewardship-initiated, department-wide, TOC program requiring all clinical pharmacists to review discharge antibiotic prescriptions in real time. Results: In total, 260 antibiotic prescriptions were assessed for appropriateness: 140 before implementation and 120 after implementation. After implementation, the number of prescriptions considered inappropriate significantly decreased by 18% (52% vs 34%; P =.005). Inappropriate rates decreased in all assessment categories: dosing (15% vs 2%; P <.001), treatment duration (42% vs 31%; P =.08), antibiotic selection based on infection type or microbiology (8% vs 4%; P =.33), and antibiotics not indicated (16% vs 10%; P =.18). Median total antibiotic days decreased by 1 day after implementation (10 days vs 9 days; P =.67), and 30-day readmission rates were similar between both phases. Conclusions: A real-time, pharmacist-driven, TOC program for oral antibiotic prescriptions had a significant impact in reducing inappropriate prescribing of antibiotics at hospital discharge for common infections. Incorporating discharge antibiotic prescription review into pharmacist daily workflow may be a sustainable approach to outpatient antimicrobial stewardship in a setting with limited resources.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Halcomb, Sarah M.; Johnson, Arianne; and Kang-Birken, S. Lena, "Impact of a pharmacy department-wide transitions-of-care program on inappropriate oral antibiotic prescribing at hospital discharge" (2022). Pacific Faculty Work. 235.
https://scholarlycommons.pacific.edu/all-faculty/235
