Improving Care for Critically Ill Patients with Community-Acquired Pneumonia

Authors

Monica L. Bianchini, Henry Ford Health
Nicholas J. Mercuro, Henry Ford HealthFollow
Rachel M. Kenney, Henry Ford HealthFollow
Michael A. Peters, Henry Ford HealthFollow
Linoj P. Samuel, Henry Ford HealthFollow
Jennifer Swiderek, Henry Ford HealthFollow
Susan L. Davis, Henry Ford HealthFollow

Recommended Citation

Bianchini ML, Mercuro NJ, Kenney RM, Peters MA, Samuel LP, Swiderek J, and Davis SL. Improving Care for Critically Ill Patients with Community-Acquired Pneumonia. Am J Health Syst Pharm 2019; 76(12):861-868.

Document Type

Article

Publication Date

6-3-2019

Publication Title

American journal of health-system pharmacy

Abstract

PURPOSE: The purpose of this study was to improve antimicrobial management and outcomes of critically ill patients with community-acquired pneumonia (CAP) through implementation of a pharmacist-driven bundle for ordering evidence-based diagnostic tests in a medical intensive care unit (MICU).

METHODS: An inpatient collaborative practice agreement (CPA) was established for MICU pharmacists to order criteria-driven diagnostic testing for CAP from November 2017-March 2018. Adults admitted to the MICU and started on empiric antibiotics for CAP were included. The intervention arm was compared with a standard of care (SOC) group from November 2016-March 2017.

RESULTS: Ninety-one patients were included in each group. There was no difference in the median antibiotic duration between SOC and CPA, at 7 days (interquartile range [IQR], 6-10) versus 7 days (IQR, 6-8), respectively. The overall use of evidence-based diagnostic tests increased in the CPA group. Patients in the CPA group had more frequent pathogen identification (SOC and CPA, respectively: 31 [34%] versus 46 [51%], p = 0.035) and antimicrobial deescalation (24 [26%] versus 53 [58%], p < 0.001). There was no significant difference in length of intensive care unit stay, at 4 days for SOC (IQR, 2-10) versus 6 days for CPA (IQR, 3-10), and no significant difference in inpatient all-cause mortality (13 [14%] versus 7 [8%]), retreatment 14 [15%] versus 11 [12%]), or 30-day readmission 16 ([18%] versus 13 [14%]) for SOC and CPA, respectively. The CPA was the only variable that was independently associated with antimicrobial deescalation (odds ratio, 4.030; 95% confidence interval, 2.101-7.731) in a multiple logistic regression.

CONCLUSION: Implementation of a pharmacy-driven pneumonia diagnostic stewardship bundle improved the use of evidence-based diagnostics and increased the frequency of pathogen identification. This intervention was associated with increased antimicrobial deescalation without a negative impact on patient safety outcomes.

PubMed ID

31361849

Volume

76

Issue

12

First Page

861

Last Page

868