1942. Randomized Trial of Team Pharmacist-Led Antimicrobial Time Out
Session: Poster Abstract Session: Antibiotic Stewardship: Pharmacist Led Interventions
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Time Out Poster Final.pdf (632.1 kB)
  • Background: The CDC has advocated for antimicrobial “time out” implementation to improve antimicrobial use, but little data exists on the impact of such interventions.

    Methods: Six medicine teams were randomized to implementation of a team pharmacist-led antimicrobial time out (TO) or usual care (UC). Pharmacists in the TO group received education and used standardized questions to facilitate TOs on rounds targeting two time points: early (<72 hours after antibiotic start) and late (after early, ≤5 days after antibiotic start). Time out were perfromed on allo patients, but only those meeting inclusion criteria were analyzed: age≥19, medicine primary, received antibiotics ≥ 48 hours. ICU days were excluded; antibiotic use was measured in days of therapy (DOT) per patient day (PD).

    Results: A total of 260 (120 TO, 140 UC) patients with 293 admissions were included. Demographics were similar between groups: overall 46.9% male, 77.5% admitted to medicine, median age and Charlson score 62 and 2, respectively. Infections were similar between groups with respiratory tract (28.7%), skin-soft tissue/bone (24.2%), and genitourinary (21.8%) most common. TOs were performed 152 times; TO compliance was 72% for early and 70.3% for late. Common TO outcomes were: no change (N=80), narrow antibiotics (N=29), ID consult (N=21), and change to PO (N=13). Clinical outcomes and antibiotic use data are in Table 1. In the TO group oral conversion was more frequent (54.7% vs. 44.2%, P=0.08), time to oral conversion was earlier (2.43 vs. 3.39 days, P=0.14), the proportion of PO antibiotics prescribed increased (39.1% vs. 29.6%), and the ratio of PO to IV antibiotic days was significantly higher (1.14 vs. 0.54, P=0.01) compared to the UC group.

    Table 1

    Time Out (N=139)

    Usual Care (N=154)

    P

    ID Consult

    47 (33.8)

    49 (31.8)

    0.71

    Stewardship Intervention

    11 (7.9)

    21 (13.6)

    0.09

    Readmission

    35 (25.2)

    49 (31.8)

    0.24

    ICU Transfer

    17 (12.2)

    16 (10.4)

    0.71

    C. difficile Infection

    5 (3.6)

    2 (1.3)

    0.26

    Any Antibiotic Adverse Event

    30 (21.6)

    33 (21.4)

    1.00

    DOT/1000 PD

    1190

    1101

    0.39

    IV DOT/1000 PD

    739

    780

    0.98

    PO DOT/1000 PD

    465

    326

    0.44

    Conclusion: Introduction of a pharmacist-led antimicrobial time out did not decrease antibiotic use, but was associated with earlier and more frequent use of oral therapy.

    Trevor C. Van Schooneveld, MD1, Mark E. Rupp, MD, FIDSA, FSHEA1, Elizabeth Lyden, MS2, R Jennifer Cavalieri, RN1, Cole Marolf, Medical Student3 and Kiri Rolek, PharmD4, (1)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (2)Epidemiology, University of Nebraska Medical Center, Omaha, NE, (3)University of Nebraska Medical Center, Omaha, NE, (4)University of Nebraska Medical Center College of Pharmacy, Omaha, NE

    Disclosures:

    T. C. Van Schooneveld, Merck: Grant Investigator , Research grant

    M. E. Rupp, None

    E. Lyden, None

    R. J. Cavalieri, None

    C. Marolf, None

    K. Rolek, Merck: Grant Investigator , Research grant

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