Pharmacist-led urine culture follow-ups in a rural emergency department.

BACKGROUND: Urinary tract infections (UTIs) are a common indication for antibiotic prescriptions in the outpatient setting. With rising antimicrobial resistance, eliminating unnecessary antibiotics is critical. Previous research has shown that pharmacist-led antimicrobial stewardship in the emergency department (ED) setting can reduce the number of unnecessary antibiotics and increase appropriate antibiotic prescribing. By expanding the scope of ED pharmacists to include antimicrobial stewardship initiatives, rural EDs can better justify pharmacy involvement in the ED. OBJECTIVE: To determine whether pharmacist review of urine cultures in a rural ED leads to an improvement in antimicrobial stewardship outcomes. METHODS: This was a hybrid, quality improvement study conducted in a 12-bed, rural hospital ED. Data were collected from October 15, 2021, through April 15, 2022, 3 months before (preintervention) and after (postintervention) pharmacists assumed the responsibility for reviewing ED urine cultures from the nursing staff. For each urine culture, a pharmacist conducted a patient chart review and determined whether an intervention was required. If action was required, the pharmacist provided a recommendation to an ED provider and subsequently implemented the agreed on action. Primary study outcomes included (1) the number of discontinued antibiotics when there was no bacterial infection cultured and (2) when changing antibiotics on the basis of culture results, whether the antibiotic chosen matched current guidelines. Primary postintervention outcomes were compared with preintervention ones using the Fisher exact tests. RESULTS: Pharmacist review in the postintervention period led to a statistically significant higher number of discontinued antibiotics than in the preintervention period (20/65 vs. 0/71, P < 0.001). The antibiotics chosen when altering therapy on the basis of culture results did not differ statistically significant between the pre- and postintervention periods (P > 0.999). CONCLUSION: Pharmacist review of urine cultures in a rural ED can improve antimicrobial stewardship outcomes by decreasing unnecessary antibiotic use for the treatment of UTIs.

2018 American Society of Consultant Pharmacists Annual Meeting & Exhibition.

Poster abstracts are evaluated based on the following criteria: significance of the problem to healthy aging or medication management; innovativeness of ideas, methods, and/or approach; methodological rigor of methods and approach; presentation of finding; implications identified for future research, practice, and/or policy; and clarity of writing. Submissions are not evaluated through the peer-reviewed process used by The Consultant Pharmacist. Industry support is indicated, where applicable. Presenting author is in italics. The poster abstract presentation is supported by the ASCP Foundation.

What types of nursing facilities are more likely to adopt a pharmacist's medication review recommendations?

BACKGROUND: Few studies in the literature have analyzed the determinants of pharmacist drug therapy recommendations in nursing facility settings, and those that have focus primarily on accepted/rejected recommendations by disease state. OBJECTIVE: To identify the set of nursing facility characteristics that are more likely to adopt a pharmacist's medication review recommendations. DESIGN: Cross-sectional, retrospective methods are used to examine 53 licensed nursing facilities receiving medication review services from a small independent consultant pharmacist practice with no ties to vendor pharmacy functions. SETTING: Nursing facilities in rural areas of central and western Minnesota in 2008. INTERVENTION: Medication review services. MAIN OUTCOME MEASURES: The number of recommendations made and accepted, which are aggregated to the level of the nursing facility. Poisson regression analysis is used to identify those nursing facility characteristics that predict total recommendations and total accepted recommendations. Data obtained from Medicare's Web site on each nursing facility's operating characteristics and quality indicators serve as covariates. RESULTS: At the 5% level, patient census (positively), greater certified nursing assistant staffing hours (positively), multisite facilities (positively), resident residency councils (negatively), and greater perceptions of registered nurse quality (negatively) predict a greater number of recommendations. Patient census (positively), greater licensed practical nurse staffing (negatively), having residency councils (negatively), and greater perceptions of registered nurse quality (negatively) significantly predict the number of accepted and implemented recommendations. CONCLUSION: Institutional specific factors, most notably, quality-of-care indicators, may affect a nursing facility's acceptance of a pharmacist's drug therapy review.

Preliminary evaluation of medication therapy management services in assisted living facilities in rural Minnesota.

OBJECTIVES: While pharmacists are providing medication therapy management (MTM) services, few programs have been assessed for outcomes, particularly those in rural areas. The objectives are to: 1) categorize the number and type of drug-therapy problems (DTPs) that were identified by consultant pharmacists in assisted living facilities, 2) assess resident and administrator satisfaction of consultant pharmacist MTM services, and 3) assess the direct costs of providing MTM services and make some preliminary inferences about the program's economic viability. DESIGN: We conducted a cross-sectional, pilot study at 14 assisted living facilities over a 12-month period. SETTING: 14 rural assisted living facilities. PATIENTS: Assisted living facility residents. INTERVENTION: MTM visits were performed by a consultant pharmacist based on the MTM model developed by the American Pharmacists Association. MAIN OUTCOME MEASURES: Patient satisfaction, clinical (DTPs), and economic costs. RESULTS: 130 residents were enrolled with a mean age of 86 years, with 77.7% female. Residents were taking an average of 13 medications (range = 1-29), including prescription and nonprescription drugs. Common medical conditions were hypertension (80.0%), hyperlipidemia (37.7%), and diabetes (20.8%). Residents had an average of 9 comorbidities (range = 2-16) and 304 DTPs (mean 2.3 per resident). Residents reported high mean satisfaction levels with the pharmacist and the services provided. Direct costs of the intervention were $20,372.96, which suggests that only modest gains in overall patient health (or a few major avoided adverse events) caused by the intervention are necessary to ensure the program's economic viability. CONCLUSION: Through the use of MTM programs to resolve medication problems, pharmacists can improve patient satisfaction with care among assisted living facility residents.

A formal synthesis of swainsonine by gold-catalyzed allene cyclization.

A formal synthesis of swainsonine has been achieved using a highly efficient and diastereoselective gold(III)-catalyzed allene cyclization.

Economic impact of a pharmacy resident in an assisted living facility-based medication therapy management program.

BACKGROUND: Pharmacists now have the opportunity to be reimbursed for providing medication therapy management (MTM) services. With 5% of the elderly population living in senior housing such as assisted living facilities, MTM programs need to be evaluated in this setting. OBJECTIVE: To evaluate the economic impact of a postgraduate year 1 (PGY1) pharmacy practice resident's interventions while performing MTM in an assisted living facility. METHODS: We conducted a prospective, evaluative study at an assisted living facility over 184 days. Patients included in the study were aged 57-100 years. MTM visits were performed by the PGY1 resident, based on the American Pharmacists Association consensus definition of the model of MTM services. The pharmacy resident prospectively collected data, including interventions made and patient demographics. Drug therapy recommendations were categorized and assessed for cost savings and acceptance by a primary care provider. RESULTS: Fifty-three patients were enrolled in the study (mean age 85.3 y). Patients were taking an average of 12 medications (prescription and nonprescription). The pharmacy resident made 125 recommendations to primary care providers; 72 of those were addressed and 90.3% of addressed recommendations were accepted. The largest category to elicit drug therapy recommendations was dose appropriateness. Of the 72 addressed recommendations, 17 (23.6%) resulted in direct cost savings totaling $3774. Costs that accrued as a result of drug therapy recommendations totaled $693. The resultant net cost-benefit was $1550, with a benefit-to-cost ratio of 1.7 and a return on investment of 70%. CONCLUSIONS: Our study demonstrates the positive value that a PGY1 pharmacy resident has on an assisted living-based MTM program, with respect to a positive drug-related cost-benefit and drug therapy recommendation acceptance.