Pharmacist-led feedback workshops increase appropriate prescribing of antimicrobials

Inappropriate antimicrobial prescribing is a common occurrence in hospitals, and may lead to increased patient morbidity. Not only does this produce deleterious effects for individual patients, but it also contributes to the growing global health problem of anti-microbial resistance. Research has indicated that most inappropriate antimicrobial prescriptions are written by junior doctors in their first 2 years of practice. Therefore, initiatives targeting these junior doctors and educating them on proper antimicrobial use may increase individual health outcomes and help alleviate the problem of antimicrobial resistance.

A European study aimed to reduce inappropriate antimicrobial prescriptions by targeting junior doctors with intervention provided by pharmacists. This was done via data collection on junior doctors’ prescribing habits, followed by feedback workshops aimed at addressing knowledge gaps, discussing social and behavioral aspects of prescribing, and encouraging reflection. 29 doctors were recruited for the study, 14 were randomized to the intervention group and 15 were randomized to the control group. The normalized rate of suboptimal prescribing was significantly lower for the intervention group than the control group. Analysis showed that pharmacist intervention increased junior doctors’ awareness of their prescribing behavior.

This article was a prime example of how pharmacist intervention in drug therapy can improve health outcomes, both on an individual and public health scale. Often, I feel doctors hesitate to consult pharmacists about drug therapy unless the drug being provided is a particularly complex or new drug (such as chemotherapy or psychiatric drugs). Something as commonplace as antimicrobials is not typically seen as being a serious enough drug to warrant pharmacist opinion. However, it is clear that by including pharmacists in the decision-making process on antimicrobial prescriptions and allowing them to educate prescribers, better health outcomes can be achieved. How do you think pharmacists can become more involved in the decision-making process and education for prescribing more commonplace medications, such as antibiotics, antivirals, etc.? Especially in an outpatient setting where pharmacists are often not on-site?

McLellan L, Dornan T, Newton P, et al. Pharmacist-led feedback workshops increase appropriate prescribing of antimicrobials. J Antimicrob Chemother. pii: dkv482. [published 2016 Feb 24]

Implementation of Penicillin Allergy Screening Tool to Optimize Aztreonam Use

In this article from the American Journal of Health System Pharmacy, researchers looked to determine whether pre-screening for a penicillin allergy could help to reduce the use of aztreonam.  Aztreonam is an antibiotic used to treat gram-negative infections.

The study looked at patients prior to and after intervention to account for inappropriate aztreonam use.  After intervention, the number of inappropriate doses decreased significantly.  And overall, the screening allowed for a cost avoidance of up to $100,000.  Use of B-lactam alternatives became more popular over the use of aztreonam.

This article is interesting because it shows that educating providers and doing pre-screening can help patients receive the appropriate medication and avoid adverse reactions.

Stacie ML, Brundige ML, Brown J, et al.  Implementation of a penicillin allergy screening tool to optimize aztreonam use.  Am. J. Health Syst. Pharm.  2016;73:298-306.