981. Healthcare Providersí Use of an Antibiotic Time Out for Antibiotic Stewardship in Inpatient Settings
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

Appropriate antibiotic use minimizes resistance and toxicity but often involves complex decision-making. Healthcare providers often make reflexive decisions about antibiotic prescribing because of competing cognitive demands. Work in dual process theory by cognitive psychologists demonstrates that decision makers often rely on heuristics or “rules of thumb” in order to minimize effort. We conducted a formative evaluation of a “time out” decision support tool to improve antibiotic decision-making, specifically continuation of vancomycin during a patient’s hospitalization. Taking a “time out” was proposed to increase deliberation and deeper reasoning.

The time out intervention consisted of an electronic dashboard that informed the decision of whether to continue vancomycin, a paper-based clinical summary to prompt the timeout during rounds on the third calendar day of vancomycin, and a templated note that educated users and documented the reasons for continuing vancomycin.

Methods:

Focus groups in a VA medical center were conducted to understand clinical reasoning, workflow processes, and reactions to the intervention. Four internal medicine house staff teams, one ICU team, and a team of three clinical pharmacists were interviewed. ATLAS.ti software was used for qualitative analysis.

Results:

Six themes emerged from the analysis across three categories (Table 1).

Table 1: Themes from qualitative analysis

 

Category

Themes

Description

Reasoning

“It helped me to think”

Increases attention to antibiotic renewal task, display had all information in one place

 

Uncertainty reduction

Provides education information; patient’s clinical condition easier to evaluate

Affective

Increased autonomy

Eliminates requirement for approval from ID pharmacist or weekend consults

 

Increased responsibility

Concerns about not having sufficient back up

Workflow

Changed role of clinical pharmacist

Fewer interruptions and more time for deeper chart review

 

Effort management

Discontinuations viewed as easier than filling out the form; letting the pharmacist decide was less effort

Conclusion:

A “time out” intervention for improving appropriate antibiotic prescribing appears to have multiple impacts on clinical reasoning and decision-making.

Jorie Butler, PhD, University of Utah, Salt Lake City, UT, UT; Psychology, University of Utah, Salt Lake City, UT, UT; VA Salt Lake City Health Care System, Salt Lake City, UT, UT, Charlene Weir, PhD, Biomedical Informatics, University of Utah, Salt Lake City, UT, UT; IDEAS, VA Salt Lake City Health Care System, Salt Lake City, UT, UT, Christopher Graber, MD, MPH, VA Greater Los Angeles Healthcare System, Los Angeles, CA, Matthew Samore, MD, University of Utah School of Medicine, Salt Lake City, UT, Makoto Jones, MD, MS, Internal Medicine, University of Utah School of Medicine Division of Epidemiology, Salt Lake City, UT, Peter Glassman, MBBS, MSc, VA Greater Los Angeles Health Care System, Los Angeles, CA, Los Angeles, CA and Matthew Bidwell Goetz, MD, Infectious Diseases, VA Greater Los Angeles Healthcare System , Los Angeles, CA

Disclosures:

J. Butler, None

C. Weir, None

C. Graber, None

M. Samore, None

M. Jones, None

P. Glassman, None

M. Bidwell Goetz, None

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