Taking an Antibiotic Timeout: Utilizing an Antibiotic Renewal Template for Automatic Approval of Vancomycin and Piperacillin-tazobactam
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.
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).
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.
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.
C. J. Graber,
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