Pharmacy Optimization of Antibiotic Verification and Preparation for Pediatric Emergency Department Patients: A...

The primary aim of this project was to improve the rate of prospective pharmacy verification of antibiotics in the emergency department (ED). We also aimed to streamline the process for intravenous (IV) antibiotic preparation and delivery without causing significant delays in antibiotic administration.

This retrospective evaluation compared pharmacist order verification rates for IV and oral antibiotics pre and post intervention between September 2021 and April 2022. Primary intervention involved modifications to the pharmacist verification queue and workflow prioritization. Process measures included time from order placement to pharmacy verification, pharmacy delivery, and administration. Statistical analysis of median times before and after the process change was conducted by using the Mann-Whitney U test. Control charts were used to illustrate the effect of the intervention over the defined period.

During the evaluation period, a total of 2545 IV and oral antibiotic doses were ordered in the ED. The process change resulted in an increase in the number of ED IV and oral antibiotic orders verified before administration from 63% (875/1388) to 93% (1076/1157). There were substantial reductions in the pharmacy's median time to IV antibiotic order verification from 21 minutes to 7 minutes (IQR, 4-13; p < 0.05), and median time to IV antibiotic order delivery from 43 minutes to 27 minutes (IQR, 18-38; p < 0.05). Overall time to the first administrated IV antibiotic remained largely unaffected by the process change (50 vs 51 minutes; p = 0.16).

Implementation of mandatory pharmacy verification and preparation of IV doses in a high acuity environment like the ED is feasible without compromising antibiotic administration times.