Evaluation of the impact of a pharmacist-run antimicrobial report in reducing delays in subsequent antibiotic administration in patients in the emergency department.

PURPOSE: To determine whether the implementation of a pharmacist-run, real-time electronic health record (EHR) antimicrobial report reduces the frequency of delays in subsequent antibiotic medication administration timing in patients in the emergency department (ED). METHODS: A single-center, retrospective, pre-and-post quasi-experimental study was conducted between July and December 2021 following the implementation of an antimicrobial EHR report of adult patients presenting to the ED who were continued on antibiotic therapy after receiving a one-time dose of an antibiotic in the ED. The primary objective was to determine the impact of the pharmacist-run, real-time EHR antibiotic dosing report in the ED on reducing the number of major delays in subsequent antibiotic administration times. A subanalysis of the primary outcome was performed to evaluate differences in major delays based on specific dosing intervals of 6, 8, and 12 hours. RESULTS: A total of 521 subsequent antibiotic dosing orders from 273 patient encounters were analyzed, with major delays in subsequent antibiotic dosing administration times identified in 20% of the intervention group compared to 27% of the control group (P = 0.047). Major delays were also significantly decreased in the intervention group compared to the control group for antibiotics dosed at 8-hour intervals (18% vs 32%; P = 0.026). No significant difference in delays was observed between the groups for antibiotics dosed at 6-hour intervals (18% vs 27%) or 12-hour intervals (29% vs 21%). CONCLUSION: Implementing a real-time EHR antimicrobial report run by pharmacists in the ED was associated with significantly fewer major delays in subsequent antibiotic dosing following a first dose.

Impact of a resident-driven wellbeing committee on resident-perceived wellbeing, burnout, and resilience.

BACKGROUND: Limited data exists to guide strategies that reduce risks of burnout amongst pharmacy residents. OBJECTIVE: The primary objective of this analysis was to characterize wellbeing, burnout, and resiliency among pharmacy residents. The secondary objective was to assess the impact of a resident-run wellbeing committee on wellbeing, burnout, and resiliency. PRACTICE DESCRIPTION: In 2018, a wellbeing committee was developed at an academic medical center with the aim of promoting wellbeing and resilience amongst pharmacy residents. PRACTICE INNOVATION: The wellbeing committee functions through 3 workgroups focused on resources, engagement, and advocacy. Collectively, these workgroups aim to facilitate wellbeing discussions, plan mindfulness events, and advocate for policies to enhance the wellbeing of residents. EVALUATION METHODS: Pharmacy residents were invited to participate in an electronic survey aimed at characterizing resident wellbeing and assessing the impact of a resident-led wellbeing committee on wellbeing, burnout, and resiliency. The Resident & Fellow Wellbeing Index (RFWI) and Brief Resilience Scale (BRS) were utilized to assess burnout and resiliency, respectively. Continuous and categorical endpoints were assessed utilizing student t tests and chi-square tests, respectively. RESULTS: A total of 16 of 38 residents participated in this analysis. Scores for RFWI and BRS remained stable throughout the 16-week period. RFWI scores demonstrated that up to 50% of residents scored as "at risk" at any point during the study period, while over 80% of respondents maintained high levels of resilience. More than 50% of respondents reported a positive impact of the wellbeing committee on their wellbeing, burnout, and resilience. CONCLUSION: A resident-led wellbeing committee demonstrated favorable impact on wellbeing, burnout, and resilience for majority of pharmacy residents. While this data suggests that such a committee may serve to protect residents from the negative impacts of burnout, future studies are necessary to further elucidate strategies to promote resident wellbeing.

Efficacy of 4-Factor Prothrombin Complex Concentrates in Factor Xa Inhibitor-Associated Intracranial Bleeding.

BACKGROUND/OBJECTIVE: Intracranial bleeding (ICB) is a feared complication of systemic anticoagulation. Factor Xa inhibitors (FXaI) are used frequently due to their improved safety profile and predictable kinetics. Andexanet alfa was recently approved for emergent reversal of FXaI agents but was not compared formally to 4-Factor Prothrombin Complex Concentrates (4FPCC) which are the current standard of care in many centers. The objective of this study is to formally evaluate the hemostatic efficacy of 4FPCC in patients with FXaI-associated ICB. METHODS: We performed a retrospective cohort study of patients receiving 4FPCC for the reversal of a FXaI in the setting of acute ICB. Hemostatic efficacy was adjudicated via evaluation of post-4FPCC CT scan using the criteria closely mirroring those outlined in Annexa-4 (excellent < 20% expansion, good > 20% but ≤ 35% expansion, poor > 35% expansion). Each image was reviewed by two neurointensivist attendings for grading. Mortality was assessed until date of discharge. Charts were screened for thrombotic events out to 30 days post-4FPCC administration. RESULTS: A total of 59 patients were included in the final analysis. The mean age in years was 78.5 ± 10.9 and 56% were male. Apixaban was the most common FXaI prescribed at the time of presentation (67.8%). Most patients were on FXaI therapy for stroke prevention in the setting of atrial fibrillation (81.3%). Median Glasgow Coma Scale at presentation was 15(IQR 12-15), with the most frequently presenting ICB type being intracerebral hemorrhage (52.5%). The mean dose of 4FPCC prescribed was 46.6 (± 8.2) units/kg. Of those receiving 4FPCC for FXaI ICB, 88% were graded as having an excellent or good hemostatic outcome with excellent interrater reliability. Survival was high at 89.8%, and thrombotic events were seen in seven patients (11.9%). CONCLUSION: 4FPCC appears to be an effective and safe option for FXaI-associated ICB with outcomes comparable to andexanet alfa. A formal prospective evaluation of this strategy versus andexanet alpha including cost analysis is warranted.