Implementation of a Pharmacist-Led Culture and Susceptibility Review System in Urgent Care and Outpatient Settings

Increasing prevalence of antibiotic resistance is an urgent public health threat. The purpose of this project is to implement a pharmacist-managed culture review service to decrease and prevent inappropriate use of antibiotics. This service will intervene in cases of mismatched antibiotic-bacteria combinations to decrease health care provider (HCP) and nursing interruptions, improve patient outcomes, and enhance prescribing practices to reduce occurrence of antibiotic resistance.

Patients requiring changes in antibiotic therapy after culture and susceptibility results were identified through the electronic health record. After results were returned, pharmacists assessed the antibiotic for appropriateness. If the isolated organism was not susceptible to the empiric antibiotic, the pharmacist adjusted the regimen, counseled the patient, documented the intervention electronically, and notified the HCP via an electronic note. Follow-up phone calls assessed for adverse effects and answered patient questions. Pharmacists could change antibiotic therapy without contacting HCPs because of an antimicrobial stewardship care coordination agreement between HCPs and pharmacists. Previously, HCPs were responsible for evaluating culture and susceptibility results as well as adjusting antimicrobial regimens. After implementing this project, 10 interventions were made out of 320 patients from August 2019 to February 2020.

Appropriateness of antibiotic therapy through antimicrobial stewardship could help combat the significant public health issue of antibiotic resistance.