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Purpose: To investigate challenges encountered when antimicrobial stewardship programs are implemented in the emergency department and identify potential solutions to overcome these challenges.
Methods: A literature search on PubMed, The International Pharmaceuticals Abstracts, Cochrane and OVID was conducted. The keywords typed were: “antimicrobial stewardship AND emergency department”, or “antibiotic AND emergency department AND clinical pharmacist”. Descriptive analysis was conducted to assess challenges encountered by various institutions when implementing antimicrobial stewardship programs in their ED. Documented potential solutions will be discussed.
Results: The search led to fifteen articles and abstracts. Three articles and four abstracts were included in this review. Challenges that emerged included: complications to obtain the bacterial culture results, depending on the hospital information technology systems or barriers to follow-up effectively and in a timely manner with patients and/or their primary care physicians. ED pharmacists may also face time constraint especially for cultures requiring immediate review. Documented solutions included appointing a specific person (provider and/or ED pharmacist) to be contacted by the microbiology laboratory to facilitate and expedite the process, educating ER providers by developing clinical pathways and simplified algorithms to assist them when the ED pharmacist is not present due to schedule or staffing issues, or creating a multidisciplinary Quality Initiative committee.
Conclusion: This literature review confirms that organizational barriers to implement antimicrobial stewardship programs in the ED exist. There is no denial; however, that antimicrobial stewardship is beneficial to the ED. Our analysis will give insight on how these challenges can be overcome, depending on the type and size of the hospital and the type of clinical pharmacy services offered.