Cost analysis of one-time intravenous antibiotic doses in the emergency department.

BACKGROUND: Research shows that one-time doses of intravenous (IV) antibiotics do not improve resolution of infection. Providers, however, continue to use them - especially in the emergency department. Very few studies have aimed to quantify the cost of this practice. OBJECTIVES: The primary objective was to evaluate the difference in average total cost of emergency department (ED) stay between patients who received a one-time dose of intravenous antibiotics in the ED before discharging on oral antibiotics and patients who were just discharged on oral antibiotics. Secondary objectives were to evaluate the differences in durations of stay between the two groups, as well as the differences in adverse drug effects and need for healthcare contact after discharge. METHODS: Chart review was conducted to identify patients who received and did not receive a one-time dose of IV antibiotics in the ED between April 30, 2020, and April 30, 2022. A micro-costing approach was used to determine ED-associated costs per patient. Comparisons in primary and secondary outcomes were performed using statistical inferential tests. RESULTS: A total of 102 patients were analyzed in each group. Patients who received a one-time dose of intravenous antibiotics in the emergency department before being discharged on oral antibiotics had an average length of stay of 4.55 hours, as opposed to patients who did not receive a one-time dose of intravenous antibiotics before being discharged on oral antibiotics who had an average length of stay of 2.82 hours (absolute difference: 1.73 hours, p < 0.001). One-time dosing of intravenous antibiotics in the emergency department incurred an additional cost of approximately $556 per patient, totaling to over $56,000 in our study cohort. CONCLUSION: The use of one-time intravenous antibiotics in the emergency department did not confer any additional benefits to patients. Use of one-time doses resulted in significantly reduced throughput in the emergency department and significantly increased healthcare costs.

Assessment of an education tool to improve knowledge and reduce stigma of a syringe service program (SSP) at a VA Medical Center.

BACKGROUND: Drug overdose deaths are a growing epidemic in the United States owing in part to inadequate support from health care systems. In response, the Veterans Health Administration (VHA) plans to implement syringe service programs (SSPs) across VHA medical centers. This SSP education project aims to positively affect health care staff perceptions regarding SSPs and reduce the stigma surrounding substance use. OBJECTIVES: The purpose of this research was to allow Advanced Pharmacy Practice Experience (APPE) students to implement and assess an educational program regarding SSP enactment at this institution. Furthermore, the objectives of the educational program were to address the stigma associated with substance use and provide knowledge to staff about SSPs. PRACTICE DESCRIPTION: Eleven complete and one abbreviated (no questionnaire) presentations were delivered by APPE students throughout the main facility and outpatient clinics, with presentations being delivered to physicians, nurses, and a range of other professions. PRACTICE INNOVATION: APPE students developed educational content and pre- and postsurveys that were used to assess for changes in knowledge and perception surrounding substance use and SSPs. EVALUATION METHODS: The primary outcome was to assess individual pre- and postprogram survey responses using mean, SD, and mean change to measure the impact that the presentation had on individualized stigma. RESULTS: A total of 104 completed surveys were analyzed in Microsoft Excel and subcategorized by profession; 10 of the 15 questions asked in the questionnaire yielded statistical significance when comparing pre- and postpresentation results (P < 0.05). CONCLUSIONS: A presentation method developed and delivered by APPE students resulted in a statistically significant change in perception and knowledge, proving to be an effective method for educating health care staff on SSPs.

Implementation of a Patient Medication Disposal Program at a VA Medical Center.

A pharmaceutical take-back program assisted patients with disposal of unwanted and expired medications, promoted safety and environmental stewardship, and reduced the risk of diversion.

Analyzing the Clinical Outcomes of a Rapid Mass Conversion From Rosuvastatin to Atorvastatin in a VA Medical Center Outpatient Setting.

Background: Medication conversions occur frequently within the Veterans Health Administration. This manual process involves several pharmacists over an extended period of time. Macros can automate the process of converting a list of patients from one medication to a therapeutic alternative. Objectives: To develop a macro that would convert active rosuvastatin prescriptions to atorvastatin and to create an electronic dashboard to evaluate clinical outcomes. Methods: A conversion protocol was approved by the Pharmacy & Therapeutics Committee. A macro was developed using Microsoft Visual Basic. Outpatients with active prescriptions for rosuvastatin were reviewed and excluded if they had a documented allergy to atorvastatin or a significant drug-drug interaction. An electronic dashboard was created to compare safety and efficacy endpoints pre- and postconversion. Primary endpoints included low-density lipoprotein (LDL), creatine phosphokinase (CPK), aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase. Secondary endpoints evaluated cardiovascular events, including the incidences of myocardial infarction, stroke, and stent placement. Results: The macro was used to convert 1520 patients from rosuvastatin to atorvastatin over a period of 20 hours saving $5760 in pharmacist labor. There were no significant changes in LDL, AST, ALT, or secondary endpoints (P > .05). There was a significant increase in alkaline phosphatase (P = .0035). Conclusions: A rapid mass medication conversion from rosuvastatin to atorvastatin saved time and money and resulted in no clinically significant changes in safety or efficacy endpoints. Macros and clinical dashboards can be applied to any Veterans Health Administration facility.

Development of a Virtual Pharmacy Resident Conference.

A virtual conference for pharmacists and residents offered a cost-effective means to share research findings across facilities.