Pharmacist-led antibiotic timeout feasible, did not change overall antibiotic use
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A pharmacist-led antibiotic timeout was found to be feasible and well accepted by hospital teams. However, it did not change overall antibiotic use, researchers reported in Infection Control & Hospital Epidemiology.
“We have a robust stewardship program at our institution, but even with that, we can't evaluate every patient on antibiotics. Stewardship expertise is a limited quantity, and we were seeking to find a way to improve antibiotics that didn't require stewardship expert input,” Trevor C. Van Schooneveld, MD, FACP, associate professor of infectious diseases and medical director of the antimicrobial stewardship program at the University of Nebraska Medical Center, told Healio. “Also at the time, the CDC and Joint Commission were promoting timeouts as a means to improve antibiotic use and there was little literature to support their effectiveness, and so we wanted to evaluate their utility in a rigorous manner.”
During a 2-month intervention, referred to as phase A, the hospital implemented pharmacist-led antibiotic timeouts (ATOs) on three medicine teams, whereas three other teams maintained usual care to evaluate the effectiveness of an ATO led by a team-based pharmacist. According to the study, this was followed by a 2-month B phase, during which ATOs were continued in the ATO group (ATO-B) and ATOs were initiated in the usual care group (UC ATO-B)
According to the study, there were 290 ATOs among 538 admissions. The researchers found that the most common ATO recommendations were to narrow therapy (148 of 290), not change therapy (124 of 290) and change to oral administration (30 of 290).
Data from the study demonstrated that antimicrobial timeouts could be relatively easily integrated into daily rounds using someone with drug expertise already on the team a team-based pharmacist in this case. Van Schooneveld said that team members and pharmacists “appreciated the interaction” and believed it was “helpful to patient care.”
The study also showed that the intervention rate was highly variable among pharmacists even though they received the same training.
“There are a number of possible explanations for this, including variable comfort level with antimicrobials and infection management, team dynamics and willingness to accept recommendations, assertiveness of the pharmacist in making recommendations, or lack of documentation,” Van Schooneveld explained.
Lastly, the study found that ATOs did not seem to have much of a measurable impact on antimicrobial use. ATO initiation was lower in the UC ATO-B group than in either initial ATO group (21.8% UC ATO-B vs. 69.2% ATO-A and -B). Researchers found some suggestion with transition of IV quinolones to oral administration, but overall, there was very little impact.
“While antimicrobial timeouts make clinical sense and we would love to have people self-regulate their antibiotic use through simple self-auditing mechanisms, they just don’t seem to have much impact,” Van Schooneveld said. “This may be because our center has a robust antimicrobial stewardship program, but other studies have demonstrated similar findings. Our assessment was that we should seek other avenues to improve antibiotic use and not invest our time and resources in antimicrobial timeouts.”
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