In this episode, I’ll discuss a pharmacist-driven deprescribing protocol for negative urine and sexually transmitted infection cultures in the emergency department.
When pharmacists begin to provide in-person services to the Emergency Department, one of the first areas to achieve an impact that everyone is satisfied with is the ED culture callback program. These programs exist because when a culture is started for an ED patient that is discharged home, the ED providers are still responsible for monitoring and acting on the results of the culture despite the fact that the patient has been discharged. Pharmacists are a natural fit for reviewing culture results for discharged patients as they can identify patients that require further provider review and at the same time provide recommendations to the provider on what the best pharmacotherapy option is for the patient. It is a pure win-win scenario as the pharmacist gets to make their interventions and at the same time they dramatically decrease the tedious workload of culture review that would otherwise fall on the provider to complete.
A group of pharmacists from the Loyola Medical University Center ED recently published an evolution of the culture callback review with a pharmacist-driven deprescribing protocol for patients with negative urine and sexually transmitted infection cultures.
The study design was single-center, prospective, observational, pre-post intervention and the primary outcome was the number of calendar days within 28 days after urine culture or STI test collection that patients did not receive any antibiotic treatments.
The pre-intervention group had 63 patients and the post-intervention group had 26 patients. Antibiotic free days represented 35.1% in the pre-intervention group and an impressive 80.5% in the post-intervention group.
The authors concluded by saying:
This study showed that a pharmacist-driven protocol increased the number of antibiotic-free days for patients prescribed empiric antibiotic therapy and discharged from the ED with subsequent negative urine cultures and STI results. We propose taking a novel approach in discontinuation of antibiotics by implementing an expansion of ED culture programs to include negative cultures that promote antimicrobial stewardship.
If you already have a culture callback program with pharmacist involvement in your ED, adding this type of protocol might significantly increase the number of antibiotic free days for your patients with negative UTI and STI culture results.
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If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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