Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department

Authors

  • Emily L. Bauman, PharmD Saint Vincent Hospital https://orcid.org/0000-0002-7276-0928
  • Justine M. Russell, PharmD Saint Vincent Hospital
  • Angela R. Morelli, PharmD Saint Vincent Hospital

DOI:

https://doi.org/10.33940/data/2022.1.1

Keywords:

emergency room, emergency department, emergency medicine, antibiotic prescriptions, oral antibiotics, discharge antibiotics, antimicrobial stewardship

Abstract

IMPORTANCE: Every year, thousands of emergency department (ED) visits result in patients being discharged with oral antibiotic prescriptions. Published studies that assess the appropriateness of these antibiotic regimens are limited.

PURPOSE: The purpose of this study was to examine the appropriateness of antibiotic prescriptions written for patients discharged from a community hospital’s ED.

ENDPOINTS: The primary objective was to determine the overall percent of appropriate antibiotic prescriptions for patients discharged from the ED. Secondary objectives included the following: identify reasons for inappropriateness categorized by antibiotic selection, dose, duration, and allergies; identify the most common antibiotics prescribed inappropriately as well as the most common disease states that led to inappropriate prescribing of antibiotics; and analyze prescribing trends based on provider type and time of day the prescription was written.

STUDY DESIGN AND METHODS: Patients eligible for inclusion were adults age 18 and older who presented to the ED during four chosen weeks in 2019 and who were discharged with oral antibiotics. Extracted electronic health record data was reviewed to identify the discharge diagnosis for each patient that met the inclusion criteria. Pertinent information gathered from the patients’ medical records along with a validated antimicrobial assessment tool were utilized to determine the level of appropriateness of the prescribed antibiotic regimens.

RESULTS: A total of 76% of the prescribed antibiotics were appropriate, 16% were inappropriate, and the remaining 8% were not assessable. Duration was the most common reason for a regimen to not be optimal. The most frequently inappropriately prescribed antibiotics included cephalexin (but it is noted cephalexin was included in almost half of the antibiotic regimens in this study), clindamycin, and azithromycin. Infections that were most frequently treated inappropriately were skin and soft tissue infections, dental infections, and sinusitis. Overall, medical residents prescribed the highest percent of appropriate regimens, and the time of day that had the highest percent of appropriate prescriptions was third shift (11 p.m. to 7 a.m.).

CONCLUSION AND RELEVANCE: Almost half of all the nonoptimal antibiotic regimens had an excessive duration. Targeted local education efforts and future clinical decision support can facilitate appropriate prescribing of discharge antibiotics from the ED, ultimately improving antimicrobial stewardship within the community.

Author Biographies

Emily L. Bauman, PharmD, Saint Vincent Hospital

Emily L. Bauman (Emily.Bauman@va.gov) is a pharmacist at the Veterans Affairs Medical Center in Erie, Pennsylvania. She graduated from Lake Erie College of Osteopathic Medicine School of Pharmacy in 2020 and finished a PGY1 pharmacy residency at Saint Vincent Hospital in Erie in 2021. Her areas of interest include infectious diseases, internal medicine, and ambulatory care.

Justine M. Russell, PharmD, Saint Vincent Hospital

Justine M. Russell is a clinical pharmacy specialist in emergency medicine at Saint Vincent Hospital in Erie, Pennsylvania, a part of the Allegheny Health Network. She graduated from the University of Pittsburgh School of Pharmacy and completed a PGY1 pharmacy practice residency at Saint Vincent Hospital in Erie. Russell is a board-certified pharmacotherapy specialist and she enjoys teaching pharmacy residents and students the unique needs of the emergency department. Other professional interests include fostering multidisciplinary teamwork and advocating for safe medication practices.

Angela R. Morelli, PharmD, Saint Vincent Hospital

Angela R. Morelli is a clinical pharmacy specialist in infectious disease at Saint Vincent Hospital in Erie, Pennsylvania, a part of the Allegheny Health Network. She graduated from Lake Erie College of Osteopathic Medicine School of Pharmacy and completed an acute care PGY1 pharmacy residency at University of Pittsburgh Medical Center Hamot in Erie. Morelli maintains dual board certification in pharmacotherapy as well as infectious disease and serves on the board of Pennsylvania Society of Health-System Pharmacists (PSHP). Her primary areas of interest include antimicrobial stewardship and teaching pharmacy residents and students.

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Pharmacist holding pencil over prescription pad, with 2 bottles of pills on ground.

Published

2022-01-12

How to Cite

Bauman, E. L., Russell, J. M., & Morelli, A. R. (2022). Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department. Patient Safety, 4(SI), 10–19. https://doi.org/10.33940/data/2022.1.1
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