Pharmacist-led Intervention to Improve Antibiotic Use at Hospital Discharge

More than half of the pharmacist led interventions were accepted by providers during the intervention period.

Antimicrobial Stewardship programs are of significant importance when it comes to patient care and the use of antibiotics. Institutions which implement such programs typically see a decrease in antibiotic use, cost and antibiotic associated infections.

However, a worrying trend has been emerging in that inappropriate antibiotic use at hospital discharge has become more common, resulting in regimens that are often too long, inappropriately dosed, or too broad in spectrum.

Recently, investigators from the Moses H. Cone Memorial Hospital, in collaboration with the Fred Wilson School of Pharmacy at High Point University, have conducted research to evaluate discharge antibiotic prescribing, as well as to provide a specific, pharmacist-led intervention at improve appropriate antibiotic use.

The data was presented at the 23rd Annual Making a Difference in Infectious Disease Meeting 2021 virtual sessions.

The quasi-experimental, pre-post study evaluated 162 patients who were 18 years of age or older and were discharged from the hospital with an oral antibiotic prescription. The primary outcome was appropriate antibiotic prescribing at discharge defined as appropriate duration, dosing, and spectrum.

Two groups were included, a retrospective group evaluated a random sample of patients discharged in February of 2020 and a prospective group included patients discharged between January and April 2021.

Findings from the study showed that of the 162 participants, 86 (53.1%) were discharged on inappropriate antimicrobial therapy, excessive duration being the principal driver.

Among the patients who were treated with an inappropriate duration of therapy, the average duration was seen to be shorter in the prospective group (2.8 vs 4.6 days, p = 0.003). Of the pharmacist led interventions, 37 (66.1%) of 56 were accepted by providers in the intervention period.

“Here, we have demonstrated that prospective evaluation of discharge antibiotic therapy by a clinical pharmacist improves appropriateness of discharge antibiotic prescriptions, especially through optimization of duration of outpatient antibiotic therapy,” the authors wrote. “The prospective results from this study are promising, demonstrating that this innovative approach can potentially improve outpatient oral antibiotic prescribing and provide a framework for other institutions to implement similar programs.”