Related Experiment Video
Updated: Mar 15, 2026
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Impact of prospective verification of intravenous antibiotics in an ED
Allyson Hunt1, Steven Nakajima1, Lisa Hall Zimmerman1
1Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC.
Background:
Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED.
Methods:
This retrospective, institutional review board-approved preimplementation vs postimplementation study evaluated patients 18years or older who were started on IV antibiotics in the ED. Patients were excluded if pregnant, if the patient is a prisoner, if no cultures were drawn, or if the patient was transferred from an outside facility. Appropriate antibiotic therapy was based on empiric source-specific evidence-based guidelines, appropriate pharmacokinetic and pharmacodynamic properties, and microbiologic data. The primary end point was the time from ED arrival to administration of appropriate antibiotic therapy.
Results:
Of the 1628 evaluated, 128 patients met the inclusion criteria (64 pre vs 64 post). Patients were aged 65.2±17.0years, with most of infections being pneumonia (44%) and urinary tract infections (18%) and most patients being noncritically ill. Time to appropriate antibiotic therapy was reduced in the postgroup vs pregroup (8.1±8.6 vs 15.2±22.8hours, respectively, P=.03). In addition, appropriate empiric antibiotics were initiated more frequently after the implementation (92% post vs 66% pre; P=.0001). There was no difference in mortality or length of stay between the 2 groups.
Conclusion:
Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of antibiotics by pharmacists led to significant improvement on both empiric selection of and time to appropriate antibiotic therapy.
Insights
Implementing pharmacist review of emergency department antibiotic orders significantly reduced the time to appropriate antibiotic therapy. This intervention improved the selection of empiric antibiotics, ensuring timely and correct treatment for infections.
Area of Science:
- Pharmacology
- Infectious Diseases
- Health Services Research
Background:
- Delayed antibiotic administration increases patient mortality and hospital stay duration.
- Automatic dispensing machines expedite antibiotic delivery but risk inappropriate use without pharmacist oversight.
- Prospective pharmacist verification aims to mitigate risks associated with automated antibiotic dispensing in emergency settings.
Purpose of the Study:
- To evaluate the impact of prospective pharmacist verification on the time to appropriate antibiotic therapy in the emergency department.
- To compare the time to appropriate antibiotic administration before and after the implementation of pharmacist-led antibiotic review.
Main Methods:
- A retrospective, pre- vs. post-implementation study design was employed.
- Patients aged 18 years or older receiving intravenous antibiotics in the emergency department were included.
- Appropriate antibiotic therapy was defined by evidence-based guidelines, pharmacokinetics/pharmacodynamics, and microbiological data.
Main Results:
- The time to appropriate antibiotic therapy significantly decreased post-implementation (8.1 hours vs. 15.2 hours, P=.03).
- Appropriate empiric antibiotic selection increased from 66% pre-implementation to 92% post-implementation (P=.0001).
- No significant differences were observed in mortality or length of stay between the groups.
Conclusions:
- Prospective pharmacist verification of emergency department antibiotic orders demonstrably improves timely administration of appropriate therapy.
- This intervention enhances the accuracy of empiric antibiotic selection, crucial for effective infection management.
- Pharmacist involvement is vital for optimizing antibiotic use in acute care settings.
Related Concept Videos
01:19Dosage Interval and Administration Route: Determination Methods
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence
01:20Estimation of k and VD of Aminoglycosides
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography