2026 Southeastern Residency Conference

Background
Autoverification is the process in which a medication is automatically verified after provider order entry, without pharmacist review.  Autoverification of antimicrobials in the emergency department was implemented following health system integration to align with system-wide autoverification practices; however, this was subsequently reverted to reinstate pharmacist verification. Timely administration of antimicrobials has long been recognized as a cornerstone of improving patient outcomes, particularly in those with sepsis. While most autoverification studies focus on quality and process improvement, there is limited data on the impact on clinical outcomes. To address this gap, this study examined if there is a difference in timely administration between autoverified and pharmacist verified antimicrobials. 

Methods
A retrospective chart review of patients bedded in the adult and pediatric emergency departments who received an initial dose of oral or parenteral antimicrobial between November 16th, 2024 and January 16th, 2025, was conducted. Eligible patients were separated into two groups: the control group, during which autoverification of antimicrobials was permitted, and the intervention group, during which autoverification of antimicrobials was not allowed. The primary outcome was administration of antimicrobials within one hour of order entry. Secondary outcomes included pharmacist intervention rates and alerts per 100 orders.   

Results
A total of 300 orders from 235 patients were included in the analysis, 150 orders in the control group; 150 orders in the intervention group. Significant differences in patient demographics were observed for age, race, and infections (abdominal, bloodstream/catheter-related, empiric/unknown). A significant difference was also observed in the order characteristics for the dispense location. One hundred and three (68.7%) orders in the control group and 87 (58%) of orders in the intervention group were administered within one hour (x2 = 3.67, (p = 0.055)).  Compared with the control group, the intervention group observed higher rates of pharmacist intervention (1.33 vs 20 per 100 orders; IRR, 15; 95% CI, 3.58–62.7) and alerts (58 vs 104 per 100 orders; IRR, 1.79; 95% CI, 1.38–2.33). 

Conclusion
This study found no difference in administration of antimicrobials within one hour between the control and intervention groups. The intervention group generated more alerts and required greater pharmacist involvement. Together, these findings suggest that excluding antimicrobials from autoverification does not negatively impact timely administration of antimicrobials and may preserve the safety benefits associated with pharmacist verification. 



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