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Cluster randomized trial of an antibiotic time-out led by a team-based pharmacist

Published online by Cambridge University Press:  20 August 2020

Trevor C. Van Schooneveld Open the ORCID record for Trevor C. Van Schooneveld [Opens in a new window] ,
Mark E. Rupp ,
R. Jenifer Cavaleiri ,
Elizabeth Lyden  and
Kiri Rolek
Trevor C. Van Schooneveld*
Affiliation:
Division of Infectious Disease, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Mark E. Rupp
Affiliation:
Division of Infectious Disease, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
R. Jenifer Cavaleiri
Affiliation:
Division of Infectious Disease, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Elizabeth Lyden
Affiliation:
College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
Kiri Rolek
Affiliation:
College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska Department of Pharmacy, Nebraska Medicine, Omaha, Nebraska
*
Author for correspondence: Trevor C. Van Schooneveld, E-mail: tvanscho@unmc.edu
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Abstract

Objective:

Antibiotic time-outs (ATOs) have been advocated to improve antibiotic use without dedicated stewardship resources, but their utility is poorly defined. We sought to evaluate the effectiveness of an ATO led by a team-based pharmacist.

Design:

Cluster randomized controlled trial.

Setting:

Six medicine teams at an academic medical facility.

Patients:

Inpatients who received antibiotics and were cared for by a medicine team.

Intervention:

In phase A (2 months) pharmacist-led ATOs were implemented on 3 medicine teams (ATO-A) while 3 teams maintained usual care (UC-A). In phase B (2 months), ATOs were continued in the ATO group (ATO-B) and ATOs were initiated in the UC group (UC ATO-B). We targeted 2 ATO points: early (<72 hours after antibiotics were initiated) and late (after the early period but ≤5 days after antibiotic initiation).

Results:

In total, 290 ATOs were documented (181 early, 87 late, and 22 subsequent) among 538 admissions. The most common ATO recommendations were narrow therapy (148 of 290), no change (124 of 290), and change to oral (30 of 290). ATO initiation was lower in the UC ATO-B group than in either ATO group (21.8% UC ATO-B vs 69.2% ATO-A and -B). Overall antibiotic use was not different between the groups (P = .51), although intravenous (IV) levofloxacin use decreased in the UC group after ATO implementation (49 DOT/1,000 PD vs 20 DOT/1,000 PD; P = .022). The ratio of oral (PO) to intravenous (IV) DOT was lower in the UC group than in any of the ATO groups (P = .032). We detected no differences in mortality, length of stay, readmission, C. difficile infection, or antibiotic adverse events.

Conclusions:

Implementation of a pharmacist-led ATO was feasible and well accepted but did not change overall antibiotic use. An ATO may promote increased use of oral antibiotics, but more effective strategies for self-stewardship are needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 11 , November 2020 , pp. 1266 - 1271
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION. The preliminary data from this study were presented at IDWeek 2016, on October 28, 2016, in New Orleans, Louisiana.

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