# Untapped potential: exploring clinical pharmacists as antibiotic stewardship ambassadors

## TL;DR

This study shows that clinical pharmacists help improve antibiotic use in hospitals, especially when working closely with antimicrobial stewardship programs.

## Contribution

The study demonstrates that pharmacist interventions increase the likelihood of successful antibiotic stewardship recommendations.

## Key findings

- Clinical pharmacists made over 5,000 interventions on injectable antibiotic orders during the study period.
- PAF cases with prior pharmacist interventions had a significantly higher rate of stewardship recommendations (38% vs 34%).
- Antibiotic dose optimization was the most common type of pharmacist intervention.

## Abstract

To describe inpatient clinical pharmacists’ interventions on injectable antibiotics and assess their impact on prospective audit and feedback (PAF) by the antimicrobial stewardship program (ASP).

Retrospective cohort study.

Freestanding, quaternary-care, pediatric and obstetric hospital.

We identified all clinical pharmacist interventions (iVents) documented on injectable antibiotics from November 1, 2020, through October 31, 2022. PAF performed on injectable antibiotics during the same timeframe was captured. We reported characteristics of clinical pharmacist iVents on injectable antibiotics. We also compared the incidence of PAF recommendations (PAFR) between PAF cases with prior iVent documentation for the same patient and antibiotic and those without preceding iVent documentation.

A total of 5,277 iVents were documented on injectable antibiotic orders. Cefazolin had the highest volume of iVents (13%). Antibiotic dose optimization was the most frequent iVent type (34%). A total of 5,152 PAF were documented by ASP pharmacists on injectable antibiotics during the study period, with 1,782 (34%) resulting in a PAFR. A total of 999 PAF (19%) had a prior iVent; 4,153 PAF did not. Comparing the two groups, the incidence of a PAFR was significantly higher in the PAF with prior iVent group compared to the PAF without prior iVent group (383/999, 38% vs 1,399/ 4,153, 34%; P = 0.006). Antibiotic discontinuation was the most common type of PAFR in both groups.

Clinical pharmacists serve as ASP ambassadors, intervening on injectable antibiotic orders to improve prescribing. Future efforts to expand and incorporate clinical pharmacists in ASP initiatives are warranted.