Antimicrobial Time-Out for Vancomycin by Infectious Disease Physicians Versus Clinical Pharmacists: A Before-After Crossover Trial

Abstract

Background The present study assessed the impact of time-out on vancomycin use and compared the strategy’s efficacy when led by pharmacists versus infectious disease (ID) physicians at a tertiary care center. Methods Time-out consisting of a telephone call to inpatient providers and documentation of vancomycin use > 72 hours was performed by ID physicians and clinical pharmacists in the Departments of Medicine and Surgery/Critical Care. Patients in the Department of Medicine were assigned to the ID physician-led arm, and patients in the Department of Surgery/Critical Care were assigned to the clinical pharmacist-led arm in the initial, six-month phase and were switched in the second, six-month phase. The primary outcome was the change in weekly days of therapy (DOT) per 1,000 patient-days (PD), and vancomycin use was compared using interrupted time-series analysis. Results Of 587 patients receiving vancomycin, 132 participated, with 79 and 53 enrolled in the first and second phases, respectively. Overall vancomycin use decreased although the difference was statistically non-significant (change in slope, −0.25 weekly DOT per 1,000 PD; 95% confidence interval, −0.68 to 0.18, p = 0.24). The weekly vancomycin DOT per 1,000 PD remained unchanged during phase 1 but decreased significantly in phase 2 (change in slope, −0.49; −0.84 to −0.14, p = 0.007). Antimicrobial use decreased significantly in the surgery/critical care patients in the pharmacist-led arm (change in slope, −0.77; −1.33 to −0.22, p = 0.007). Conclusions Vancomycin time-out was moderately effective, and clinical pharmacist-led time-out with surgery/critical care patients substantially reduced vancomycin use.

Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study

“…To evaluate the effect of the ASP in this study, we measured processes such as changes in antibiotic use and outcomes associated with these changes. Although the DOT as a process measure has been reported to decrease in prior studies, the effectiveness of ATOs in reducing mortality has not been determined (11–15). In this study, the difference in the hospital discharge rate was almost negligible (phase 1, 92.0%; phase 2, 93.7%) and not significant with the chi-square model.…”

“…A prescriber-driven ATO at 48 to 72 hours of treatment with paper or electronic medical record ATO tools has been reported to decrease inappropriate antibiotic therapy and days of therapy (DOT) with antibiotics (11)(12)(13). Similarly, pharmacistdriven ATO was reported to be associated with more frequent assessments and changes in antibiotic use (14) and was also more effective in reducing the use of vancomycin in comparison with interventions by ID specialists (15).…”

The role of the clinical pharmacist in antimicrobial stewardship in Asia: A review

“…24 A timeout intervention for vancomycin showed a decrease in weekly vancomycin days of therapy (DOT) per 1,000 patient day (coefficient, −0.49; P = .007) as well as a decrease antimicrobial usage in the pharmacist-led arm (coefficient, −0.77; P = .007) compared to an ID physician arm. 25 Finally, a study in Japan reported that clinical pharmacist involvement in an ASP team reduced the volume of antimicrobial prescriptions in a skilled nursing facility (incidence rate ratio [IRR], 0.885; P < .001) (Figure 1). 26 Several clinical-pharmacist-led ASP studies have been conducted in Thailand.…”

Approaches to Reduce Use and Duration of Anti-MRSA Agents for Antimicrobial Stewardship Programs: A Review of Recent Literature

“…They suggest that prospective review and feedback and pre-prescription restrictions are 2 of the most effective actions and as such will be reviewed first. 23 Table 1 [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] summarized the actions employed and outcomes.…”

“…Summary of Studies Utilizing 1 Primary ASP Action and Impact on Anti-MRSA Therapy [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. …”