Evaluation of pharmacist-led strategy to reduce outpatient fluoroquinolone prescribing from the emergency department

Document Type

Article

Publication Title

Journal of the American Pharmacists Association

ISSN

1544-3450

Volume

60

Issue

6

DOI

10.1016/j.japh.2020.03.023

First Page

804

Last Page

808

Publication Date

11-1-2020

Abstract

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of a pharmacist-led initiative to reduce outpatient fluoroquinolone prescribing in the emergency department (ED).

DESIGN: Eight common indications for fluoroquinolone prescribing were selected for intervention. The intervention consisted of a multimodal prescriber education program providing empirical recommendations for antibacterial agents on the basis of guidelines, the local ED antibiogram, and clinical trials. The electronic medical record was reviewed to identify all prescriptions for moxifloxacin, ciprofloxacin, and levofloxacin oral tablets written at the time of discharge by ED providers.

SETTING AND PARTICIPANTS: This study was conducted in a 62-bed emergency department at an academic community medical center with approximately 90,000 ED visits per year. Adult patients who were prescribed an oral fluoroquinolone at discharge from the ED were included.

OUTCOME MEASURES: The primary outcome of the study was fluoroquinolone days of therapy (DOT) prescribed per 100 ED visits.

RESULTS: In the preintervention group, the primary outcome of fluoroquinolone DOT per 100 ED visits was 18.4, 17.8, 16.5, 19.8, and 16.8 for the months of December 2017 through April 2018, respectively. The fluoroquinolone DOT per 100 ED visits in the postintervention group was 8.7, 7.9, 8.0, 6.3, and 6.0 for the months of December 2018 through April 2019, respectively. The fluoroquinolone DOT per 100 ED visits was found to be significantly shorter in the postintervention group with P = 0.009.

CONCLUSION: The results of this study reveal that pharmacist-led interventions, focused on multimodal provider education, were effective at reducing ED discharge prescriptions for fluoroquinolones.

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