980. Implementing an “Antibiotic Timeout” as an Antimicrobial Stewardship Initiative at an Academic Medical Center
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

Much of antimicrobial prescribing is unnecessary or inappropriate. The Centers for Disease Control and Prevention (CDC) has advocated implementing taking an “Antibiotic Timeout” (ATO) where prescribing clinicians formally assess on clinical rounds three pieces of essential information:  correct dosing, duration of therapy, and indication for treatment.   Formal ATO facilitates ongoing drug review.

Methods:

Education about and implementation of formal ATO was undertaken as an antimicrobial stewardship program (ASP) initiative at The Ohio State University Wexner Medical Center (OSUWMC) beginning in mid-2012 on several hospital services:  the medical and surgical intensive care units (MICU/SICU), bone marrow transplant unit (BMTU), and hospitalist services. A clinical champion was chosen for each service and implementation was individualized based on the service needs and patient population. MICU used paper checklists with rounding; other services also used checklists but indicated ATO in the progress notes of the electronic medical record. Compliance audits of patients on antimicrobials were conducted in participating services from November 2012 to February 2013:  reviews of paper checklists for MICU patients; medical record audits in SICU and BMTU; electronic queries of key phrases in hospitalist services.

Results:

Compliance with ATO in the MICU was 76/105 (72%). In the SICU, 57/102 (56%) had the entire checklist completed; 88/102 (86%) listed the current antimicrobial agents; and 74/102 (73%) had the indication for treatment.  In the BMTU, 26/40 (65%) indicated formal ATO was held, 37/40 (93%) listed the current drugs and 39/40 (98%) outlined indication for therapy. On the hospitalist services, the presence of key phrases consistent with ATO is monitored over time and has increased to 30-55%.

Conclusion:

We demonstrate that ATO is feasible with a reasonable level of compliance on diverse clinical services reached in several months at a large medical center.  The limitation of the hospitalist service audits is they represent only an electronic query and the medical records have not yet been reviewed for validation; thus, ATO documentation may have been missed.  ATO has the potential to assist with optimization of prescribing.  Its impact on clinical outcomes warrants further study.

Kurt Stevenson, MD, MPH1, Jessica E. West, MSPH2, Meredith Deutscher, MD3, Mark Lustberg, MD, PhD2, Matthew Exline, MD4, Leslie Andritsos, MD5, Kimberly Tartaglia, MD6, Curt Walker, PhD6, Whitney Whitis, BS6 and James M. Martin, BS6, (1)Infectious Diseases, Antimicrobial Stewardship Program, Ohio State University Wexner Medical Center, Columbus, OH, (2)Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, (3)Infectious Diseases, The Ohio State University College of Medicine, Columbus, OH, (4)Internal Medicine, The Wexner Medical Center at the Ohio State University, Columbus, OH, (5)Hematology, Bone Marrow Transplant Program, The Ohio State University Wexner Medical Center, Columbus, OH, (6)Hospital Medicine, The Ohio State University Wexner Medical Center, Columbus, OH

Disclosures:

K. Stevenson, None

J. E. West, None

M. Deutscher, None

M. Lustberg, None

M. Exline, None

L. Andritsos, None

K. Tartaglia, None

C. Walker, None

W. Whitis, None

J. M. Martin, None

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