Pharmacists reviewing antimicrobial prescriptions in transitions of care practice model reduced harm

A study in JAMA Network Open found that pharmacists can play a key role in enhancing antimicrobial prescribing during transitions of care.

The study took place across 5 hospitals in the Henry Ford Health System in southeastern Michigan from September 2018 through August 2019. Researchers examined an intervention implemented in 17 distinct units at the hospitals, where clinical pharmacists worked with primary care teams to identify patients set to be discharged with antimicrobial prescriptions, determine those who may be eligible to complete the antimicrobial course with oral therapy after discharge, and provide other recommendations to optimize therapy.

Working with CDC, researchers assessed adult patients at the 5 hospitals with urinary tract, respiratory, skin, and other soft-tissue and intra-abdominal infections who were prescribed antimicrobials at discharge. The primary endpoint was the frequency of optimized antimicrobial prescriptions at discharge.

Of 400 pre-intervention and 400 postintervention patients, the most common diagnoses were pneumonia, upper respiratory tract infection and/or acute exacerbation of chronic obstructive pulmonary disease, and urinary tract infection. Patients in the postintervention group were more than 5 times more likely to have an optimal antimicrobial prescription compared with those in the pre-intervention group. The increase in optimized prescribing at discharge in the postintervention period was seen in both the academic and community hospital settings, with slightly varying methods used.

Reductions in prolonged durations of therapy, nonguideline-concordant antimicrobial selection, and treatment of asymptomatic bacteriuria contributed the most toward enhanced discharge prescribing, according to the researchers.