Atul Dilawri, PharmD
Critical Care Pharmacy Resident
NewYork Presbyterian Hospital - Columbia University Medical Center
New York, NY
Disclosure information not submitted.
Amy Dzierba, BCCCP, PharmD
Critical Care Pharmacist
New York-Presbyterian Hospital
New York, New York, United States
Disclosure information not submitted.
Alana Ciolek, PharmD
Critical Care Pharmacist
NewYork-Presbyterian Hospital, United States
Disclosure information not submitted.
Mona Patel, BCCCP, PharmD, FCCM
Clinical Pharmacy Manager, Surgical ICU
NewYork-Presbyterian Hospital
New York, NY
Disclosure information not submitted.
Title: Characterization of antimicrobial stewardship interventions made by pharmacists in ICU patients
INTRODUCTION/HYPOTHESIS: Critical care pharmacists are essential members of the interdisciplinary ICU team who help provide comprehensive management in various therapeutic areas including antimicrobial stewardship. The objective of this study was to characterize interventions associated with antimicrobial stewardship in ICU patients made by post-graduate year 2 critical care (PYG2CC) pharmacy residents during weekend shifts. We also sought to determine whether the interventions made during the weekends influenced the type and number of interventions made on Mondays by critical care pharmacists and residents.
Methods: This IRB-approved retrospective review conducted between August 2020 and May 2021 involved adult critically ill patients across nine ICUs at an academic medical center. Interventions for 39 Mondays associated with antimicrobial management documented by critical care clinical pharmacists including PGY2CC residents were assessed. Weeks involving orientation, conferences, and holidays were removed. Descriptive statistics were used to characterize interventions. Wilcoxon Rank Sum test (Mann Whitney U) was used to compare the median number of interventions made on Mondays after PGY2CC residents worked versus did not work.
Results: More than half of the interventions that PGY2CC residents made during their weekend shifts involved antimicrobial stewardship. Approximately 59% of those involved therapeutic drug monitoring with dose adjustments. Less antimicrobial stewardship interventions were made per critical care pharmacist on the Mondays immediately following a PGY2CC resident weekend shift compared to Mondays after they did not work (median 9 vs 14, p=0.016). Additionally, less dose adjustments for renal impairment (median 2 vs 4, p=0.009) occurred on Mondays immediately after residents worked the weekend vs not worked, while there was no difference in de-escalation, optimization of pharmacokinetics/pharmacodynamics, or therapeutic drug monitoring.
Conclusions: PGY2CC residents are integral members of the critical care team and contribute to important interventions outside of typical working hours. Less antimicrobial stewardship interventions were made by critical care pharmacists on Mondays after residents worked compared to when they did not work.