Department of Pharmacy Services, 577980Advocate Aurora Health, Aurora BayCare Medical Center, Green Bay, WI, USA.
Department of Pharmacy Services, 577980Advocate Aurora Health, Milwaukee, WI, USA.
J Pharm Pract. 2022 Jun;35(3):388-395. doi: 10.1177/0897190020980616. Epub 2020 Dec 23.
Antibiotic time-outs (ATO) are a recommended antimicrobial stewardship action, but data assessing their impact are lacking. This study investigated the impact of a systematic, pharmacist initiated ATO intervention.
This pre-post study included inpatients on hospitalist and intensivist services receiving empiric antibiotics for ≥48 hours. The ATO was initiated by pharmacists after 48 hours of empiric therapy and the outcome was documented including antibiotic indication, plan, and duration. An electronic medical record (EMR) alert facilitated ATO completion and pharmacists and prescribers received education prior to implementation. The primary outcome was EMR documentation of an antibiotic plan by 72 hours. Secondary outcomes included antibiotic utilization and antibiotic therapy modifications by 2 hours.
399 patients were included, 199 pre- and 200 post-intervention. The most common indications were pneumonia (32%), intra-abdominal infection (20%) and urinary tract infection (19%), with no between-group differences. EMR documentation of an antibiotic plan significantly improved in the post-intervention group (19% vs. 79%, <0.0001) as did modifications to antibiotic therapy. The median duration of in-hospital antibiotic therapy was similar between groups (4.0 vs. 4.0 days, = 0.2499). Approximately 45% of patients in each group received discharge antibiotics and median duration of discharge antibiotic therapy prescribed was reduced (7 vs. 5 days in the pre- and post-intervention groups, respectively; = 0.0140).
Implementation of pharmacist initiated ATO was associated with improvements in supporting EMR documentation and antibiotic therapy modifications. These findings highlight an important role in which pharmacists can serve as part of a collaborative antibiotic stewardship team.
抗生素暂停（ATO）是推荐的抗菌药物管理措施，但缺乏评估其影响的数据。本研究调查了系统的、由药剂师发起的 ATO 干预措施的影响。
这项前瞻性研究纳入了在住院医师和重症监护医生服务下接受经验性抗生素治疗≥48 小时的住院患者。在经验性治疗 48 小时后，药剂师启动 ATO，记录抗生素的适应证、方案和持续时间。电子病历（EMR）警报有助于完成 ATO，并且在实施前，药剂师和处方医生接受了教育。主要结局是在 72 小时内 EMR 记录抗生素方案。次要结局包括在 2 小时内修改抗生素使用和抗生素治疗方案。
共纳入 399 例患者，199 例为干预前，200 例为干预后。最常见的适应证是肺炎（32%）、腹腔内感染（20%）和尿路感染（19%），两组之间无差异。干预后组 EMR 记录抗生素方案的比例显著提高（19%比 79%，<0.0001），抗生素治疗方案的修改也有所增加。两组住院期间抗生素治疗的中位持续时间相似（4.0 天比 4.0 天，=0.2499）。每组约 45%的患者接受出院抗生素治疗，出院抗生素治疗方案的中位持续时间缩短（干预前和干预后组分别为 7 天和 5 天，=0.0140）。
实施药剂师发起的 ATO 与改善 EMR 文档记录和抗生素治疗方案修改有关。这些发现突出了药剂师可以在协作抗菌药物管理团队中发挥重要作用。
