Impact of Pharmacy-Generated Recommendations on Antibiotic Therapy in a Community Hospital

Abstract

Purpose

To examine the impact of a pharmacy-initiated antibiotic review service on the appropriateness of antibiotic therapy at a community hospital.

Methods

A retrospective review was conducted that assessed antibiotic prescribing before implementation of an antibiotic review service, followed by an interventional phase that assessed the impact of pharmacy-generated recommendations. Medical records were evaluated for appropriateness of antibiotic therapy. For records reviewed retrospectively, potential recommendations for improvement of antibiotic appropriateness were documented. Potential recommendations were based on evidence-based practice guidelines and pertained to organism susceptibilities, renal dosage adjustments, intravenous-to-oral conversion, duplication, duration, and indication for therapy. During the interventional phase, recommendations were directed to the prescribing physician via telephone or written communication. Patient charts were revisited regularly to assess for potential new recommendations and to determine acceptance of previous recommendations.

Results

At initial review, 95 (59%) orders reviewed retrospectively were considered appropriate. A total of 73 potential recommendations for improving appropriateness of retrospective orders were recorded. At completion of follow-up, overall appropriateness of retrospective orders decreased to 57%. Prospectively, 115 (57%) orders were considered appropriate at initial review. Physicians accepted 39 (71%) of the 55 recommendations generated for improving appropriateness of these orders. Pharmacy-generated recommendations were successful in improving the number of appropriate prospective orders by 13% (P = 0.004) and identified a cost savings of approximately $12,000.

Conclusion

The pharmacy-initiated antibiotic review service has been well accepted by physicians and appears to have a positive impact on the number of appropriately prescribed antibiotic orders. Complete implementation of this review service may demonstrate greater impact.