Abstract
Objective
Overall medication-related errors in the emergency department (ED) are 13.5 times
more likely to occur in the absence of an emergency medicine pharmacist (EMP). Although
the effectiveness of pharmacist-driven renal dosing adjustment has been studied in
the intensive care unit, data are lacking in the ED setting. The aim of our study
was to evaluate the appropriateness of antibiotic dosing when an EMP is physically
present in the ED compared to when absent.
Methods
This was a retrospective cohort study of patients treated in a level I trauma center
with 75 adult and 12 pediatric beds and an annual census of 90 000 patients. The study period was from March 1 to September 30, 2014. An EMP was
physically present in the ED from 11:00 to 01:30 and absent from 01:31 to 10:59. Male
and female patients 18 years and older were considered for inclusion if cefazolin, cefepime, ciprofloxacin,
piperacillin-tazobactam, or vancomycin was ordered. The primary outcome was the composite
rate of correct antibiotic dose and frequency. Statistics included a multivariable
logistic regression using age, sex, presence of EMP, and creatinine clearance as independent
predictors of correct antibiotic use.
Results
A total 210 cases were randomly chosen for evaluation, half during times when EMPs
were present and half when they were absent. There were 130 males (62%) with an overall
mean age of 54 ± 18 years. Overall, 178 (85%) of 210 of the antibiotic orders were appropriate, with 95%
appropriate when an EMP was present compared to 74% when an EMP was absent (odds ratio,
6.9; 95% confidence interval, 2.5-18.8). In a logistic regression model, antibiotic
appropriateness was independently associated with the presence of the EMP and creatinine
clearance.
Conclusion
Antibiotics that require renal and/or weight dosing adjustment are 6.5 times more
likely to be appropriate in the ED when an EMP is present. Prevalence of antibiotic
dosing error is related to both the presence of EMPs and the degree of renal impairment.
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Article Info
Publication History
Published online: February 12, 2016
Accepted:
February 10,
2016
Received in revised form:
February 1,
2016
Received:
November 26,
2015
Footnotes
☆The authors report no conflicts of interest in this study.
☆☆KD conceived the study, designed the trial, and obtained the data. SW managed the data, provided statistical advice, and analyzed the data. KD, SR, PS, AE, and SW provided oversight to the study design and data collection and drafted the manuscript. All authors contributed substantially to its revision. KD takes responsibility for the manuscript as a whole.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
