An antibiotic timeout program can improve provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances, according to recent research. The timeout gives clinicians confidence to stop the medication when they otherwise would probably seek authorization for continuation from an antimicrobial steward.
The research, led by Christopher Graber, MD, at the Veterans Administration Greater Los Angeles Healthcare System, found that antibiotic timeouts can promote critical thinking and more attention to reviewing whether continuation of antibiotics is warranted.
The timeout program consisted of an electronic antimicrobial dashboard that aggregated infection-relevant clinical data, a templated note in the electronic medical record that included a structured review of antibiotic indications and provided automatic approval of continuation of therapy when indicated, and an educational and social marketing campaign.
After six months, vancomycin was discontinued by day five in 64% of courses where a timeout was performed on day four, compared to 48% a year before the intervention. Piperacillin-tazobactam was discontinued by day five in 67%, versus 62% a year earlier.
“We sought to steer providers toward desired behavior by giving them the necessary tools to act as self-stewards and thereby respect their autonomy, rather than to explicitly restrict their actions,” the authors wrote. “The results of the analyses assessing intentions to use the template suggest that the overall approach of using a template to prompt individual assessment was acceptable to clinicians. This self-stewardship approach may also be valuable for hospitals that have limited resources to devote to stewardship.”
The full study is available online at: http://bit.ly/2m3V7KO.