Clinical Pharmacy Forum
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Service or Program: The Mayo Clinic Arizona pharmacy service, along with infectious diseases and clinical microbiology, sought to decrease time to effective antibiotic therapy in hospitalized adult patients with Gram-negative bloodstream infections (GNBSI) at a 368-bed academic medical center. A protocol was implemented in which positive blood cultures tested by microbiology using the FilmArray® BCID2 panel are immediately routed to pharmacist in-basket with 24/7 coverage. Pharmacy staff intervene and recommend antimicrobial modifications based on an institutional guidance document.
Justification/Documentation: The BCID2 panel tests for 33 pathogens and 10 resistance markers. Results are available within 2 hours from gram stain. Rapid diagnostic tests can lead to earlier initiation of effective antimicrobials leading to improved patient outcomes, including decreased mortality and hospital length of stay. Prior to the implementation, the median time to effective therapy in patients with GNBSIs currently on ineffective therapy was 30 hours. The team sought to decrease this time by at least 50% to a goal time of less than 15 hours. In the first month of post-implementation, the median time to escalation was 2.9 hours (n=5). There were 118 results reviewed by pharmacy staff within this period, culminating in 70 recommendations, of which 80% were accepted. 58/ 118 (49%) of notes contained at least one recommendation.
Adaptability: The protocol and procedure was implemented at an academic medical center and leverages all pharmacy staff including staff pharmacists across all shifts, as well as clinical specialists. The protocol in collaboration with other services can lead to an decrease in time to effective antimicrobial treatment in hospitalized patients.
Significance: This protocol highlights the importance of interdepartmental collaboration, as well as the impact of pharmacists on the healthcare team The use of rapid diagnostic tests and appropriate support can lead to a significantly decreased time to effective antimicrobial therapy.
Presenting Author
Jacob Schwarz Pharm.D., MBA, BCIDP, BCCCP, BCPS, FAzPAMayo Clinic
Authors
Andrew Bryan M.D., Ph.D
Mayo Clinic
Daniel Ilges Pharm.D., BCIDP
Mayo Clinic
Jenna Reynolds Pharm.D., BCPS
Mayo Clinic
Teresa Seville M.D.
Mayo Clinic