#81 – Making the Right Choice Easy: Antimicrobial Stewardship in the Emergency Department

Jun 16, 2023

Guest

Zack Nelson

Guest

Michael Pulia

Guest

Alison Dittmer

Experts in antimicrobial stewardship in the emergency department, Zack Nelson, Alison Dittmer, and Michael Pulia discuss communication considerations, role of lipoglycopeptides, and common stewardship interventions. They also highlight the value of having a pharmacist in the ED for antimicrobial stewardship, preferred medications in the ED, and the importance of drug choice and antimicrobial stewardship.

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Introduction

00:00 • 2min

Expertise and Passion in Emergency Medicine

01:55 • 22min

Accessibility and Guidelines in Antimicrobial Stewardship in the Emergency Department

23:31 • 16min

Developing an Antibiotic Order Set in the Emergency Department

39:28 • 8min

Optimizing Drug Administration and Admission Process in the ED

47:07 • 2min

Extended Infusion and Overcoming Resource Limitations in Antimicrobial Stewardship

49:23 • 2min

The Importance of a Pharmacist in the Emergency Department for Antimicrobial Stewardship

51:29 • 12min

Favorite Medications in the Emergency Department

01:03:41 • 2min

Choosing Drugs and the Importance of Antimicrobial Stewardship

01:05:24 • 4min

Episode Notes

Drs. Zack Nelson (@zacroBID), Alison Dittmer, and Michael Pulia (@DrMichaelPulia) join Dr. Jillian Hayes (@thejillianhayes) to discuss the ins and outs of antimicrobial stewardship in one of the busiest parts of the hospital: the emergency department! Tune in for a discussion on communication considerations in the ED, the role of lipoglycopeptides for common gram-positive syndromes, and a rapid-fire round discussing common stewardship interventions. This podcast was supported by an educational grant from Melinta Therapeutics.

References:

Pulia M, et al. Antimicrobial Stewardship in the Emergency Department. Emerg Med Clin N Am 2018;36(4):853-872. doi: 10.1016/j.emc.2018.06.012. PMID: 30297009.
Rech, Megan A et al. “PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study.” Critical Care Explorations 2021;3(4):e0406. doi:10.1097/CCE.0000000000000406. PMID: 33912836.
Sacdal JPA, Cheon E et al. Oritavancin versus oral antibiotics for treatment of skin and skin structure infections in the emergency department. Am J Emerg Med 2022;60:223-224.
Jenkins TC, Jaukoos JS et al. Patterns of use and perceptions of an institution-specific antibiotic stewardship application among emergency department and urgent care clinicians. Infection Control and Hospital Epidemiology 2020;41:212-215.
Dretske D, Schulz L, Werner E, Sharp B, Pulia M. Effectiveness of oritavancin for management of skin and soft tissue infections in the emergency department: A case series. The American Journal of Emergency Medicine 2021;43:77-80. doi: 10.1016/j.ajem.2021.01.050. PMID: 33545550.
Paul M, Pulia M, Pulcini C. Antibiotic stewardship in the emergency department: not to be overlooked. Clin Microbiol Infect 2021;27(2):172-174. doi: 10.1016/j.cmi.2020.11.015. PMID: 33253938.
Baxa J, McCreary E, Schulz L, Pulia M. Finding the niche: An interprofessional approach to defining oritavancin use criteria in the emergency department. Am J Emerg Med. 2020;38(2):321-324. doi:10.1016/j.ajem.2019.158442.
Pulia MS, Hesse S, Schwei RJ, Schulz LT, Sethi A, Hamedani A. Inappropriate Antibiotic Prescribing for Respiratory Conditions Does Not Improve Press Ganey® Patient Satisfaction Scores in the Emergency Department. Open Forum Infect Dis 2020;7(6): ofaa214. doi:10.1093/ofid/ofaa214.
Pulia MS, Lindenauer PK. Annals for Hospitalists Inpatient Notes - A Critical Look at Procalcitonin Testing in Pneumonia. Ann Intern Med. 2021;174(6):HO2-HO3. doi:10.7326/M21-1913.
Redwood R, Knobloch MJ, Pellegrini DC, Ziegler MJ, Pulia M, Safdar N. Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings. Antimicrob Resist Infect Control. 2018;7. doi:10.1186/s13756-017-0278-9.
Pulia MS, Schwei RJ, Hesse SP, Werner NE. Characterizing barriers to antibiotic stewardship for skin and soft-tissue infections in the emergency department using a systems engineering framework. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e180. doi:10.1017/ash.2022.316.
May L, Gudger G, Armstrong P, et al. Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol. 2014;35(9):1114-1125. doi:10.1086/677637.
May L, Cosgrove S, L’archeveque M, et al. A Call to Action for Antimicrobial Stewardship in the Emergency Department: Approaches and Strategies. Ann Emerg Med 2013;62(1):69-77.e2. doi: 10.1016/j.annemergmed.2012.09.002. PMID: 23122955.
Schoffelen T, Schouten JA, Hoogerwerf JJ, et al. Quality indicators for appropriate antimicrobial therapy in the emergency department: a pragmatic Delphi procedure. Clin Microbiol Infect 2021;27(2):210-214. doi: 10.1016/j.cmi.2020.10.027. PMID: 33144204.
Yadav K, Stahmer A, Mistry RD, May L. An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers. Academic Emergency Medicine 2020; 27(1):31-42. doi: 10.1111/acem.13873. PMID: 31625653.

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