Taking an Antibiotic Time-out: Utilization and Usability of a Self-Stewardship Time-out Program for Renewal of Vancomycin and Piperacillin-Tazobactam.
BACKGROUND
Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation.


OBJECTIVE
We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval.


METHODS
The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign.


RESULTS
In the first 6 months of program implementation, vancomycin was discontinued by day 5 in 93/145 (64%) courses where a time-out was performed on day 4 versus in 96/199 (48%) 1 year prior (P = .04). Seven vancomycin continuations via template (5% of time-outs) were guideline-discordant by retrospective chart review versus none 1 year prior (P = .002). Piperacillin-tazobactam was discontinued by day 5 in 70/105 (67%) courses versus 58/93 (62%) 1 year prior (P = .55); 9 continuations (9% of time-outs) were guideline-discordant versus two 1 year prior (P = .06). A usability survey completed by 32 physicians demonstrated modest satisfaction with the overall program, antimicrobial dashboard, and renewal templates.


CONCLUSIONS
By providing practitioners with clinical informatics support and guidance, the intervention increased provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances wherein they previously sought authorization for continuation from an antimicrobial steward.
VA Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles.
Christopher J
CJ
Graber
IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah; Geriatric Research and Clinical Education Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah.
Makoto M
MM
Jones
VA Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles.
Peter A
PA
Glassman
IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah; University of Utah, Salt Lake City.
Charlene
C
Weir
IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah; Geriatric Research and Clinical Education Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah; University of Utah, Salt Lake City.
Jorie
J
Butler
IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah; University of Utah, Salt Lake City.
Kevin
K
Nechodom
VA Sierra Nevada Healthcare System , Palo Alto, California, and Reno, Nevada.
Chad L
CL
Kay
VA Sierra Nevada Healthcare System , Palo Alto, California, and Reno, Nevada.
Amy E
AE
Furman
VA Greater Los Angeles Healthcare System , Los Angeles, California.
Thuong T
TT
Tran
VA Greater Los Angeles Healthcare System , Los Angeles, California.
Christopher
C
Foltz
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
Lori A
LA
Pollack
IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah; University of Utah, Salt Lake City.
Matthew H
MH
Samore
VA Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles.
Matthew Bidwell
MB
Goetz
antibacterial agents; health education; hospital infections; inappropriate prescribing; piperacillin-tazobactam; vancomycin