Title
Antimicrobial prescribing in a regional hospital: impact on prescribing
through collaboration with an on-site clinical pharmacy service
Running title:
Impact of collaborative antimicrobial prescribing in a regional hospital
Author details:
Mahsa Tantiongco- **Corresponding Author
Senior Pharmacist, SA Pharmacy, SA Health, University of South
Australia, Australia
Postal Address – Flinders Medical Centre, Flinders Drive Bedford park,
South Australia 5042
Email -
mahsa.tantiongco@sa.gov.au
Telephone number +61 433222216Pascale DettwillerLead Pharmacist: Eyre and Far North Region, SA Pharmacy, SA Health,
University of Adelaide, Adelaide Rural Clinical School, Australia
Postal Address – Port Lincoln Hospital, Oxford Terrace, Port Lincoln,
South Australia 5606
Email - Pascale.Dettwiller@sa.gov.au
Telephone number +61 8 8683 2200Stefan KowalskiProgram Director, School of Pharmacy and Medical Sciences, University of
South Australia, Australia
Postal Address – University of South Australia, City East Campus,
School of Pharmacy and Medical Sciences P5-48, North Terrace, Adelaide,
South Australia 5000
Email -
Stefan.Kowalski@unisa.edu.au
Telephone number +61 8 830 22678
Institutional Affiliation
Port Lincoln Hospital, Eyre and Far North Region, South Australia
Note corresponding authors present address as above – Flinders Medical
Centre, South Australia
Abstract
Rationale, aims and objectives
Antimicrobial Stewardship programs are critical for promoting and
monitoring judicious use of antimicrobials, however, there are many
well-established barriers to their effective implementation the rural
setting. Pharmacist involvement in such programs is recommended as part
of a multidisciplinary approach to improve appropriate antimicrobial
prescribing.
The aim of this study was to describe the impact of implementing a
clinical pharmacy service on antimicrobial prescribing in a rural GP led
hospital; explore areas of suboptimal antimicrobial prescribing; and
review the change in total antimicrobial cost per patient day.
Method:
A retrospective case series audit of pre- and post-implementation of a
new clinical pharmacy service was undertaken. All adult patients who had
presented with sepsis, cellulitis, urinary tract infections and
pneumonia between May and August 2015 and repeated for months in 2018
were included. Appropriateness of therapy was assessed using the
National Antimicrobial Prescribing Survey guidelines.
Results:
A total of 115 antibiotic orders from 2015 and 158 orders from 2018 were
included. During admission, 86% of patients (55/64) in the
post-intervention group were reviewed by a clinical pharmacist.
Appropriate prescribing increased from 57% (66/115) in 2015 to 82%
(129/158) in 2018 (P=0.001). Ceftriaxone was the most inappropriately
prescribed antimicrobial. The cost of antimicrobial therapy was halved
from $10.00 to $5.33 per patient day, pre- and post-implementation of
a clinical pharmacy service respectively.
Conclusions:
The implementation of a clinical pharmacy service in a small rural GP
led hospital can significantly improve antimicrobial prescribing
practices and provide considerable cost savings.
Main Text