Evaluation of empiric appropriateness of discharge antibiotic prescriptions from an academic medical center emergency department

Authors

  • Sara Kim Methodist Charlton Medical Center, Dallas, TX
  • Kelly Murray Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK
  • Shelton Knudsen Great Plains Regional Medical Center, Elk City, OK
  • Aaron Lane Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Tulsa, OK
  • Kendal Painter Walgreens Corporation, Tulsa, OK

Keywords:

Antibiotics, prescription errors, emergency department, pharmacist

Abstract

Addressing antimicrobial resistance has been a challenge for emergency departments (EDs) due to unclear diagnoses and the fast-paced environment. This study evaluated the appropriateness of empiric antibiotic prescriptions written upon discharge for emergency department patients and describes medication errors found in a random sample of 1000 prescriptions written over a one-year period. The investigators were trained in error identification, operational definitions, coding, and other information included in content analysis procedures. Coding for the final data set was based on majority rule, and descriptive statistics addressed the study objectives. Discharge prescription error rate out of 1000 prescriptions was 22.2%. Pediatric prescriptions had a within-group error rate of 33.3%, and adult prescriptions had a within-group error rate of 19.7%. The most common error type was due to dosing below the recommended range (19.8%). ED residents wrote the highest percentage of prescriptions (65.4%). Non-ED attending physicians had the highest within-group error rate of 31.0%. Antibiotics with the highest within-class error rate were amoxicillin, levofloxacin, and nitrofurantoin. Prescription errors made with antibiotics written upon discharge in the ED were common. Antimicrobial resistance is a growing problem that could be improved by optimizing antibiotic prescription dosing and implementing antibiotic stewardship activities in the emergency department.

References

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Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs, 2015. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2015.

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Murray KA, Belanger A, Devine LT, et al. Emergency department discharge prescription errors in an academic medical center. Proc (Bayl Univ Med Cent) 2017;30(2):143-146.

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May L, Cosgrove S, L’Archeveque M, et al. A call to action for antimicrobial stewardship in the emergency department: approaches and strategies. Ann Emerg Med 2013;62(1):doi:10.1016/j.annemergmed.2012.09.002.

Dinh A, Duran C, Davido B, et al. Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department. J Hosp Infect 2017;97(3):288–293.

Caruso MC, Gittelman MA, Widecan ML, et al. Pediatric emergency department discharge prescriptions requiring pharmacy clarification. Pediatr Emerg Care 2015;31(6):403–408.

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Published

2019-11-08

Issue

Vol. 3 No. 3 (2019)

Section

Pharmacotherapy

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