Antimicrobial optimisation in secondary care: the pharmacist as part of a multidisciplinary antimicrobial programme--a literature review.

The aims of this literature review were: (i) to determine what roles have been supported by evidence for the pharmacist in optimising antimicrobial treatment as part of an antimicrobial multidisciplinary team (AMDT) in secondary care; and (ii) to describe the outcomes of interventions of an AMDT in secondary care with pharmacy involvement. Both descriptive and primary research reports were identified and included. The hospital pharmacist emerged as a key member of the AMDT. The dispensary pharmacist was mainly involved in the screening processes and was crucial in implementing restriction policies. The general ward-based clinical pharmacist was involved in guideline development, formulary management, intravenous-to-oral conversions and evaluations of programme outcomes through monitoring of drug usage, and also facilitated identification of patients with specific needs who could be referred to the specialist pharmacist. A role emerged for the specialist pharmacist who was an integral part of the AMDT and was involved in activities including reviewing of more complex patients, attending ward rounds and streamlining of initial empirical antimicrobial treatment. Outcomes of interventions reported in primary research have been classified into: drug outcomes, where most trials measured and reported an increase in adherence to guidelines; microbiological outcomes, only considered in a few trials; clinical outcomes, with different parameters measured and a maintenance or improvement reported; and financial outcomes. The latter were reported in all trials with numerous cost savings, although not all were statistically significant. Moreover, the cost of the intervention was not always considered.