Pharmacist driven antibiotic redosing in the emergency department

Area of Science:

• Pharmacology
• Emergency Medicine
• Health Services Research

Background:

• Delays in antibiotic administration for high-risk patients in the emergency department (ED) can lead to adverse outcomes.
• Optimizing the role of pharmacists within emergency medicine (EM) settings is crucial for improving patient care and reducing hospital length of stay (LOS).

Purpose of the Study:

• To evaluate the impact of an expanded EM pharmacist scope of practice on the frequency of major delays in subsequent antibiotic administration for patients boarded in the ED.
• To assess the effect of this expanded scope on in-hospital mortality.

Main Methods:

• A pre-post, quasi-experimental study was conducted at a tertiary academic medical center.
• Adult patients receiving initial antibiotics in the ED and deemed high-risk were included. EM pharmacists reordered subsequent antibiotic doses for up to 24 hours.
• A historical control group from the previous year was used for comparison.

Main Results:

• Major delays in subsequent antibiotic administration decreased from 48% in the control group to 13% in the intervention group (p < 0.01).
• Significant reductions in delays were observed for 6-h and 8-h dosing intervals. In-hospital mortality was lower in the intervention group (3% vs. 11%, p = 0.02).
• 97% of intervention group patients received subsequent antibiotic doses while boarded, compared to 65% in the control group (p < 0.01).

Conclusions:

• Expanding the scope of practice for EM pharmacists significantly reduces major delays in subsequent antibiotic administration for boarded ED patients.
• This expanded role is associated with a decreased incidence of in-hospital mortality, highlighting its clinical benefit.