Optimizing discharge antibiotic prescribing: A multicenter evaluation of pharmacist-led interventions in community hospitals

PURPOSE: Discharge antibiotic prescriptions are infrequently monitored by hospital antimicrobial stewardship programs but are often guideline-discordant. Leveraging pharmacist expertise may optimize discharge antibiotic prescribing, benefiting the individual patient and public health. METHODS: This is a multicenter, quasi-experimental study of an intervention in which a pharmacist reviewed, documented and communicated standardized discharge antibiotic recommendations to the primary inpatient medical team. Patients were compared prior to intervention implementation (the preintervention group) to those after intervention implementation (the postintervention group). The primary outcome was overall discharge antibiotic appropriateness, defined as the prescription having an appropriate duration, agent, and dose. Clinical outcomes, including adverse drug events, 30-day hospital or emergency department readmission, and 30-day infection recurrence were compared. The pharmacist interventions in the postintervention group were classified and evaluated for provider acceptance. RESULTS: A total of 157 patients from 4 community hospitals across 3 health systems were included (87 in the preintervention group and 70 in the postintervention group). Common infection sources were the urinary tract (53.5%) and lower respiratory tract (36.3%). In the postintervention group, pharmacists made 57 interventions, most commonly proactive discharge regimen recommendations (43.9%), therapy discontinuation (26.3%), and duration adjustments (17.5%). Overall, 63.1% of interventions were accepted. Compared to the preintervention group, postintervention patients had a significantly higher frequency of discharge with an appropriate antibiotic regimen (50.0% vs 21.8%, P < 0.001). No significant between-group differences were observed in any 30-day clinical outcomes. CONCLUSION: A pharmacist-driven discharge antibiotic intervention significantly improved the appropriateness of antibiotic prescribing in community hospitals. These findings support the role of pharmacists in enhancing antimicrobial stewardship at important care transitions.