Program Schedule

236
Taking an Antibiotic Timeout: Utilizing an Antibiotic Renewal Template for Automatic Approval of Vancomycin and Piperacillin-tazobactam

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Abx timeout utilization IDWeek 2014 poster v4.pdf (981.2 kB)
  • Background:

    CDC recommends an antibiotic time out after culture results become available. We devised a self-directed time out program to guide providers to (re)consider the continuation of antibiotics past day 3.

    Methods:

    We implemented the time out program at a teaching hospital where continuation of vancomycin (VAN) and piperacillin-tazobactam (P-T) past day 3 previously required Infectious Diseases approval. We created an electronic antibiotic renewal template that included a structured review of antibiotic indications with links to local guidelines that provided automatic approval upon completion. Providers were notified of time out on day 4 via an electronic dashboard that summarized the patient’s microbiological and clinical status. We assessed template utilization in the first 6 months of implementation (4-10/2013) among providers who received time out notification  and determined via expert chart review whether self-continuation of VAN or P-T through day 5 was discordant with local guidelines as compared to a six-month period 1 year prior (4-10/2012).

    Results:

    Of 145 VAN time outs, templates were completed in 55 (38%); of these, VAN was continued through day 5 in 39. VAN was allowed to expire without template completion in 77 (53%). VAN was active through day 5 despite no template in 13 (9%).  7 continuations of VAN via template (5% of timeouts) were guideline-discordant, as compared to 0/199 1y prior (p=0.002). Overall, VAN discontinuation was higher with the time out program as compared to 1y prior: 93/145 (64%) vs. 96/199 (48%), p=0.004.

     Of 105 P-T time outs, templates were completed in 52 (49.5%); of these, P-T was continued through day 5 in 33. P-T was allowed to expire without template completion in 51 (48.5%). P-T was active through day 5 despite no template in 2 (2%). 9 continuations of P-T (9% of time outs) via template were guideline-discordant, as compared to 2/93 (2%) 1y prior (p=0.063). Overall, P-T discontinuation was similar with the time out program as compared to 1 y prior: 70/105 (67%) vs. 58/93 (62%), p=0.55.

    Conclusion:

    The self-directed time out resulted in few guideline-discordant continuations and a higher overall rate of VAN discontinuation, suggesting that the time out prompted providers to discontinue VAN in cases where they previously might have sought Infectious Diseases approval for continuation.

    Christopher J. Graber, MD, MPH, FIDSA, Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA, Makoto Jones, MD, MS, Medicine, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, Kevin Nechodom, BS, Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT, Peter Glassman, MBBS, MSc, VA Greater Los Angeles Health Care System, Los Angeles, CA, Los Angeles, CA, Jorie Butler, PhD, VA Salt Lake City Health Care System, Salt Lake City, UT, UT, Charlene Weir, PhD, IDEAS, VA Salt Lake City Health Care System, Salt Lake City, UT, UT, Amy Furman, Pharm D., VA Palo Alto Healthcare System, Palo Alto, CA, Chad Kay, Pharm. D, San Diego VAMC, San Diego, CA, Lori Pollack, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA, Matthew Samore, MD, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT and Matthew Bidwell Goetz, MD, Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA

    Disclosures:

    C. J. Graber, None

    M. Jones, None

    K. Nechodom, None

    P. Glassman, None

    J. Butler, None

    C. Weir, None

    A. Furman, None

    C. Kay, None

    L. Pollack, None

    M. Samore, None

    M. Bidwell Goetz, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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