Prevalence and risk factors of burnout in community pharmacists.

OBJECTIVES: This study aimed to identify the prevalence and risk factors for occupational burnout in community pharmacists. METHODS: Community pharmacists were solicited through a professional network e-mail Listserv to complete an anonymous, electronic survey on burnout. The survey included the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and a work-factors-based questionnaire. The MBI-HSS assessed burnout on the basis of feelings of emotional exhaustion, depersonalization, and reduced personal accomplishment. The additional questionnaire was used to evaluate risk factors for burnout by collecting information on pharmacist demographics, position characteristics, and pharmacy store characteristics. Logistic regression was performed to identify the risk factors associated with burnout. RESULTS: A total of 412 community pharmacists responded to the survey (7.4% response rate), of whom 411 were included in the final analysis. Overall, 308 (74.9%) of responding community pharmacists experienced burnout in at least 1 of the 3 subscales of the MBI-HSS. Most of the pharmacists experienced burnout owing to emotional exhaustion (68.9%), followed by depersonalization (50.4%) and reduced personal accomplishment (30.7%). The significant risk factors for burnout included shorter years of experience, practicing primarily in a chain pharmacy, and a lack of resources for burnout or resiliency. CONCLUSION: There is a high degree of burnout in community pharmacists (74.9%). Future research is warranted to examine optimal strategies to prevent burnout and promote resiliency in the profession.

Evaluation of the use of erythropoietin-stimulating agents in a hospital setting to assess the necessity of a protocol-driven anemia management service.

Erythropoietin-stimulating agents (ESA) have revolutionized the management of anemia. However, these agents are not always utilized with proper monitoring parameters, which can present significant safety concerns, unwarranted drug expenditures, and decreased ESA efficacy. This retrospective study assessed the utilization of all ESAs in non-intensive care unit hospitalized patients at a large academic medical center from August 18, 2018, to August 31, 2018, using established guideline-based assessment criteria. Among the 167 doses of ESA evaluated, 86% (n = 144) were utilized in accordance with guideline-based assessment criteria regarding laboratory monitoring of iron studies. However, 24% (n = 40) of ESA doses were administered to patients with active, untreated iron deficiency at the time of administration. Although most ESA doses were utilized in accordance with the guideline-based criteria, interventions can be implemented to further improve anemia treatment. Implementing a protocol-driven anemia management service is one strategy that can improve patient care, advance patient safety, and be cost-beneficial.

Assessment and Optimization of the Empiric Treatment of Urinary Tract Infections in an Academic Emergency Department Observation Unit.

BACKGROUND: Poor adherence to evidence-based guidelines and overuse of broad-spectrum antibiotics has been noted in the emergency department (ED). There is limited evidence on guideline-congruent empiric therapy for urinary tract infections (UTIs) and uropathogen susceptibilities in the ED observation unit (EDOU). OBJECTIVE: The primary objective was to evaluate the prescribing patterns for the empiric treatment of UTI in the EDOU. Secondary objectives were to analyze uropathogen susceptibilities in the EDOU and implement an algorithm for the empiric treatment of UTI. METHODS: This study retrospectively reviewed adult patients who received empiric UTI treatment in the EDOU from January 1, 2018 to April 1, 2018. Eligible patients were categorized as having either uncomplicated or complicated cystitis, or pyelonephritis based on their clinical diagnosis. Antimicrobial therapy was evaluated in accordance with national practice guidelines, institutional guidelines, and local antimicrobial susceptibility patterns. RESULTS: Patients with uncomplicated or complicated cystitis (n = 115) were provided guideline-congruent empiric treatment in 87% of cases. Patients with pyelonephritis (n = 35) were provided guideline-congruent empiric treatment in 57% of cases. Susceptibility patterns of uropathogens isolated from this patient sample differed slightly from the institutional antibiogram, notably depicting a lower Escherichia coli susceptibility rate. Fluoroquinolones were prescribed for a longer than recommended duration in 18 patients (60%). CONCLUSIONS: The majority of patients in this study were provided guideline-congruent empiric therapy. Nevertheless, there are opportunities to optimize empiric UTI treatment and improve antibiotic stewardship in the EDOU.