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.