Physicians' acceptance of a preformatted pharmacy intervention chart note in a community hospital antibiotic step down program

OBJECTIVE: To determine whether physicians would accept a preformatted written pharmacy intervention note suggesting a change in a patient’s drug and route of administration. DESIGN: Open-label, randomized study. SETTING: Nonacademic community hospital. PATIENTS: Fifty non-intensive-care inpatients with community-acquired pneumonia who were receiving intravenous ceftriaxone. INTERVENTION: Physicians of patients in the pharmacy intervention group (n = 25) received a written recommendation to change intravenous ceftriaxone to oral cefpodoxime. MAIN OUTCOME MEASURES: Both groups were compared for the number of patients converted to oral therapy and the occurrence of readmission. RESULTS: Patients whose physicians received an intervention chart note were switched to oral therapy in 88% of cases, compared with 36% in the control group (p = 0.000331). There was no statistical difference between groups in the number of readmissions. CONCLUSIONS: The results of this study suggest that a preformatted pharmacy intervention note can affect physician prescribing practices for patients with pneumonia in an intravenous-to-oral step-down program. This would be beneficial in nonacademic community hospitals, where direct contact with physicians is not always possible.