Implementing a pharmacist-led emergency department microbiology follow-up collaborative practice agreement

Describe the use of an emergency department (ED) pharmacist-driven microbiology follow-up collaborative practice agreement (CPA) at a community hospital ED.

A 297-bed community hospital that serves several counties in south-central Indiana.

The 40-bed ED had 48,550 visits in 2018. The clinical staff consists of 14 physicians, 14 advanced practice providers, and 2 ED pharmacists.

A CPA exists between the ED medical director and the ED clinical pharmacists. The pharmacist reviews the patient's case, culture result(s), and medications administered in or prescribed at the ED. If supported by the CPA, the pharmacist will intervene independently. If the intervention is not supported by the CPA, the pharmacist will discuss treatment options with an ED provider.

The primary end point was the number of cases reviewed and acted upon independently by the ED pharmacists using the CPA. The secondary end points included the average number of culture cases reviewed per day, average time spent daily reviewing culture data, number of cases not requiring further action under the CPA because the treatment is appropriate, type of intervention used under the CPA, number of culture cases unable to be executed under the CPA, reason for CPA exclusion, and ED provider satisfaction with the CPA. Descriptive statistics were used for data analysis.

The CPA covered 1094 microbiology follow-up cases. Of these, 36% (n = 394) required further intervention under the CPA. The CPA was unable to be used in 31% (n = 493) of the cases. Typically, a pharmacist reviewed 5.5 new cases daily over an estimated 2 hours. The ED providers strongly support the ED clinical pharmacists' current use of the CPA and also its expansion.

The CPA has several avenues for potential expansion that are being explored in response to the information gathered in this study.