Abstract
ObjectivesTo evaluate the impact and cost-benefit value of pharmacist interventions for prophylactic antibiotic use in surgical patients undergoing clean or clean-contaminated operations.MethodsA pre-to-post intervention study was performed in the Department of Urological Surgery of a tertiary hospital. Patients admitted from January through June 2011, undergoing clean or clean-contaminated surgery, served as the pre-intervention group; patients admitted from January through June 2012 formed the post-intervention group. Pharmacist interventions were performed for the surgeries in the post-intervention group. The criteria for the rational use of antibiotic prophylaxis were established by the hospital administration. The pharmacist interventions included real-time monitoring of medical records and controlling of the prescriptions of prophylactic antibiotics against the criteria. The pre- and post-intervention groups were then compared to evaluate the outcomes of the pharmacist interventions. A cost-benefit analysis was performed to determine the economic effects of implementing the pharmacist intervention on preoperative antibiotic prophylaxis.ResultsAfter the pharmacist intervention, a significant decrease was found in the rate of no indications for prophylactic antibiotic use (p = 0.004), the rate of broad-spectrum antibiotic use (p<0.001), the rate of drug replacement (p<0.001) and the rate of prolonged duration of prophylaxis (p<0.001). Significant reductions were observed in the mean antibiotic cost (p<0.001), the mean duration of antibiotic prophylaxis (p<0.001) and the mean number of antibiotics used (p<0.001). A significant increase was observed in the rate of correct choice of antibiotics (p<0.001). The ratio of the net mean cost savings for antibiotics to the mean cost of pharmacist time was approximately 18.79∶1.ConclusionReal-time interventions provided by a clinical pharmacist promoted rational use of prophylactic antibiotics, with a significant reduction in antibiotic costs, thus leading to favorable economic outcomes.
Highlights
Prophylactic antibiotics are often used by surgeons to prevent surgical site infections (SSIs) following operations [1]
Some guidelines indicate that prophylactic antibiotics appropriately administered before surgical procedures can reduce the incidence of SSIs [1,2,3,4]; inappropriate prescribing and excessive antimicrobial prophylaxis increase the risk of adverse effects and promote the emergence of resistant organisms and increase drug costs and waste healthcare resources [5]
The preintervention stage without the pharmacist served as an observational period and was performed from January 1, 2011 to June 30, 2011 to determine problems associated with preoperative antibiotic prophylaxis in surgical patients
Summary
Prophylactic antibiotics are often used by surgeons to prevent surgical site infections (SSIs) following operations [1]. Some guidelines indicate that prophylactic antibiotics appropriately administered before surgical procedures can reduce the incidence of SSIs [1,2,3,4]; inappropriate prescribing and excessive antimicrobial prophylaxis increase the risk of adverse effects and promote the emergence of resistant organisms and increase drug costs and waste healthcare resources [5]. Statistics from the National Health and Family Planning Commission (NHFPC) of China suggest that the most common prophylactic antibiotics for clean or clean-contaminated operations are third-generation cephalosporin and combinations of double beta-lactams [9]. Shi et al showed that pharmacists in China could promote the rational use of antibiotic prophylaxis in Type 1 incision operations though drug use evaluation [15]
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