Program Schedule

1328
Decreased Vancomycin Use after Implementation of a Decision Support Program for Antibiotic Time Outs

Session: Oral Abstract Session: Advancing the Science of Antibiotic Stewardship
Saturday, October 11, 2014: 11:15 AM
Room: The Pennsylvania Convention Center: 107-AB
Background:

CDC recommends a Time Out (TO) to review the need for continued antibiotic use after the first 3 days of therapy, when clinical and microbiological data become available. We evaluated the outcomes of a TO program in which providers were able to use a self-guided decision support system to obtain reapproval for vancomycin (V) and piperacillin/tazobactam (PT) therapy.

Methods:

The program was implemented in the acute medical wards and surgical and medical intensive care units in a teaching hospital with a prior policy that required reapproval by the antibiotic stewardship team after 3 days of V or PT therapy.  The intervention allowed providers to self-approve continued antibiotics upon completion of an Antibiotic Renewal Template.  The template required review of the therapeutic indication, the patient’s microbiological and clinical status, and provided links to antibiotic guidelines.  Implementation was accompanied by education and a social marketing campaign.  The analysis used segmented regression in a generalized mixed-effect model to investigate the association between the intervention and post TO cessation of targeted antibiotics. Data are presented as antibiotic days per 1000 patient-days.  Outcomes were compared for 6 month pre- and post-intervention (PreI and PostI) periods.  

Results:

The unadjusted use of V decreased from 103 (PreI) to 76.4 (PostI); the rates for PT were 53 and 49.  In adjusted models, there was a 13% decrease in vancomycin use PostI (p=0.01), but no significant change in PT use.  Adjusted models showed positive associations between the intervention (p=0.019) and increasing time since implementation (p=0.018) with the probability of stopping V after the TO.  No such associations were found for PT.  No PostI changes were observed in the frequency of C. difficile infection, ICU use, mortality or readmissions.

Conclusion:

In this single-site project, a switch from a post-prescription approval program to a program guiding providers through a self-approval process for continued V and PT use resulted in modest decreases in both overall V use and V continuation after the TO; all measures of PT use were unchanged.  This project provides a proof of principle regarding the effectiveness of a self-guided, scalable antibiotic TO approval process.

Makoto Jones, MD, MS1, Christopher Graber, MD, MPH2, Jorie Butler, PhD3, Kevin Nechodom, BS4, Jian Ying, PhD1, Yue Zhang, PhD5, Chad Kay, Pharm. D6, Amy Furman, Pharm D.7, Charlene Weir, PhD8, Peter Glassman, MBBS, MSc9, Lori Pollack, MD, MPH10, Matthew Samore, MD11 and Matthew Bidwell Goetz, MD2,12, (1)Medicine, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, (2)VA Greater Los Angeles Healthcare System, Los Angeles, CA, (3)VA Salt Lake City Health Care System, Salt Lake City, UT, UT, (4)Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (5)Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, (6)San Diego VAMC, San Diego, CA, (7)VA Palo Alto Healthcare System, Palo Alto, CA, (8)IDEAS, VA Salt Lake City Health Care System, Salt Lake City, UT, UT, (9)VA Greater Los Angeles Health Care System, Los Angeles, CA, Los Angeles, CA, (10)Centers for Disease Control and Prevention, Atlanta, GA, (11)University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, (12)David Geffen School of Medicine at UCLA, Los Angeles, CA

Disclosures:

M. Jones, None

C. Graber, None

J. Butler, None

K. Nechodom, None

J. Ying, None

Y. Zhang, None

C. Kay, None

A. Furman, None

C. Weir, None

P. Glassman, None

L. Pollack, None

M. Samore, None

M. Bidwell Goetz, None

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