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Pharmacist intervention in prescribing of cefuroxime for pediatric patients
D K Strong1, L L Dupuis, J L Domaratzki
1Department of Pharmacy, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
A pharmacist-led drug review reduced inappropriate cefuroxime prescribing in children by 16% initially. However, prescribing appropriateness returned to baseline levels after the intervention ended, highlighting the need for sustained monitoring.
Area of Science:
- Pediatric Pharmacology
- Antimicrobial Stewardship
- Health Services Research
Background:
- Rising cefuroxime costs prompted a review of its pediatric use.
- Inappropriate prescribing of antibiotics can lead to increased healthcare costs and resistance.
Purpose of the Study:
- To assess the impact of a pharmacist-led drug use evaluation on cefuroxime prescribing appropriateness in pediatric patients.
- To determine if pharmacist interventions could improve cefuroxime utilization.
Main Methods:
- A targeted drug review was conducted, assessing cefuroxime prescriptions within 48 hours and 72 hours of initiation.
- Pharmacist interventions were implemented for inappropriate orders.
- Prescribing data from before, during, and after the study period were compared.
Main Results:
- Inappropriate initial cefuroxime orders decreased from 42% (before) to 26% (during) the study, but rose to 33% (after).
- Inappropriate prescribing after 72 hours decreased from 48% (before) to 32% (during) but increased to 40% (after).
- Pharmacist interventions led to order changes in only 26% of cases.
Conclusions:
- Pharmacist interventions temporarily improved cefuroxime prescribing appropriateness in pediatric patients.
- Prescribing and monitoring habits reverted to previous levels post-intervention.
- Sustained antimicrobial stewardship programs are crucial for long-term improvements.
Abstract:
A targeted drug review of cefuroxime use in pediatric patients is described. Because of a 65% increase in cefuroxime costs over one year, pharmacists assessed the appropriateness of cefuroxime therapy from October 13 to December 20, 1987. This assessment was done within 48 hours after the prescription was written and again after 72 hours of cefuroxime therapy, when bacteriology and susceptibility data were available. When a drug order was inappropriate, a pharmacist intervened with the prescribing physician. For comparison, data collection forms were completed for patients who had received cefuroxime before and after the study period. Before the study period, 42% of the cefuroxime orders were inappropriate with respect to dosage or indication at the time of the initial order; this rate fell to 26% during the study period and increased to 33% after the study period. After 72 hours of therapy, the rates of inappropriate prescribing were 48% (before study period), 32% (during study period), and 40% (after study period). During the study period, pharmacists intervened in only half of the 51 cefuroxime orders initially deemed to be inappropriate, and only 26% of these interventions resulted in an order change. Although pharmacists met with some success in increasing the appropriateness of cefuroxime prescribing, both pharmacists and physicians resumed their previous monitoring and prescribing habits after the study period had ended.