Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin
In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to review patients on antibiotics with procalcitonin (PCT) <0.25 mcg/L. This study used a retrospective cohort design to assess change in antibiotic use from pharmacist interve...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-08-01
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| Series: | Pharmacy |
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| Online Access: | https://www.mdpi.com/2226-4787/9/3/136 |
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| author | Andrew B. Watkins Trevor C. Van Schooneveld Craig G. Reha Jayme Anderson Kelley McGinnis Scott J. Bergman |
| author_facet | Andrew B. Watkins Trevor C. Van Schooneveld Craig G. Reha Jayme Anderson Kelley McGinnis Scott J. Bergman |
| author_sort | Andrew B. Watkins |
| collection | DOAJ |
| description | In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to review patients on antibiotics with procalcitonin (PCT) <0.25 mcg/L. This study used a retrospective cohort design to assess change in antibiotic use from pharmacist interventions after this PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). The secondary outcome was antibiotic days of therapy (DOT), with a subgroup analysis examining antibiotic use and the length of stay (LOS) in patients with a pharmacist intervention. From 1/2019 to 11/2019, there were 165 alerts in 116 unique patients on antibiotics for LRTI. Pharmacists attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral being the most common interventions. Pharmacist interventions prevented 125 DOT in the hospital. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to a 27.4% discontinuation in patients without documented intervention (<i>p</i> = 0.0156). The LOS was similar in both groups (median 6.4 days vs. 7 days, <i>p</i> = 0.81). In conclusion, interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with a normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation. |
| first_indexed | 2024-03-10T07:18:43Z |
| format | Article |
| id | doaj.art-ce81bf14ba4e41a6837f8b4c8f015f4f |
| institution | Directory Open Access Journal |
| issn | 2226-4787 |
| language | English |
| last_indexed | 2024-03-10T07:18:43Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmacy |
| spelling | doaj.art-ce81bf14ba4e41a6837f8b4c8f015f4f2023-11-22T14:49:20ZengMDPI AGPharmacy2226-47872021-08-019313610.3390/pharmacy9030136Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal ProcalcitoninAndrew B. Watkins0Trevor C. Van Schooneveld1Craig G. Reha2Jayme Anderson3Kelley McGinnis4Scott J. Bergman5Department of Pharmaceutical and Nutritional Care, Nebraska Medicine, Omaha, NE 68198, USADepartment of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USADepartment of Pharmaceutical and Nutritional Care, Nebraska Medicine, Omaha, NE 68198, USADepartment of Pharmaceutical and Nutritional Care, Nebraska Medicine, Omaha, NE 68198, USADepartment of Pharmaceutical and Nutritional Care, Nebraska Medicine, Omaha, NE 68198, USADepartment of Pharmaceutical and Nutritional Care, Nebraska Medicine, Omaha, NE 68198, USAIn 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to review patients on antibiotics with procalcitonin (PCT) <0.25 mcg/L. This study used a retrospective cohort design to assess change in antibiotic use from pharmacist interventions after this PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). The secondary outcome was antibiotic days of therapy (DOT), with a subgroup analysis examining antibiotic use and the length of stay (LOS) in patients with a pharmacist intervention. From 1/2019 to 11/2019, there were 165 alerts in 116 unique patients on antibiotics for LRTI. Pharmacists attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral being the most common interventions. Pharmacist interventions prevented 125 DOT in the hospital. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to a 27.4% discontinuation in patients without documented intervention (<i>p</i> = 0.0156). The LOS was similar in both groups (median 6.4 days vs. 7 days, <i>p</i> = 0.81). In conclusion, interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with a normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation.https://www.mdpi.com/2226-4787/9/3/136antimicrobial stewardshipprocalcitoninpharmacyclinical decision support |
| spellingShingle | Andrew B. Watkins Trevor C. Van Schooneveld Craig G. Reha Jayme Anderson Kelley McGinnis Scott J. Bergman Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin Pharmacy antimicrobial stewardship procalcitonin pharmacy clinical decision support |
| title | Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin |
| title_full | Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin |
| title_fullStr | Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin |
| title_full_unstemmed | Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin |
| title_short | Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin |
| title_sort | use of a novel clinical decision support tool for pharmacist led antimicrobial stewardship in patients with normal procalcitonin |
| topic | antimicrobial stewardship procalcitonin pharmacy clinical decision support |
| url | https://www.mdpi.com/2226-4787/9/3/136 |
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