Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI.
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI.
Am J Infect Control. 2022 Jul;50(7):777-786. doi: 10.1016/j.ajic.2021.11.016. Epub 2021 Nov 28.
Antibiotic overuse at hospital discharge is common and harmful; however, methods to improve prescribing during care transitions have been understudied. We aimed to pilot a pharmacist-facilitated antibiotic timeout prior to discharge.
From May 2019 to October 2019, we conducted a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to discharge. The timeout addressed key elements of stewardship (eg, duration) and was designed and implemented using iterative cycles with rapid feedback. We evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability, using mixed methods. Pre versus postintervention antibiotic use at discharge in intervention versus control groups was assessed using logistic regression models controlling for patient characteristics.
Pharmacists conducted 288 antibiotic timeouts. Timeouts were feasible (mean 2.5 minutes per timeout) and acceptable (85% [40/48] of hospitalists believed timeouts improved prescribing). Pharmacists recommended an antibiotic change in 25% (73/288) of timeouts with 70% (51/73) of recommended changes accepted by hospitalists. Barriers to adherence included unanticipated and weekend discharges. Compared to control services, there were no differences in antibiotic use after discharge during the intervention.
A pharmacist-facilitated antibiotic timeout at discharge was feasible and holds promise as a method to improve antibiotic use at discharge.
医院出院时抗生素过度使用很常见且有害；然而，改善护理交接期间处方的方法还研究不足。我们旨在试行在出院前由药剂师协助的抗生素暂停。
从 2019 年 5 月至 2019 年 10 月，我们进行了一项单中心、对照性的药师协助的抗生素暂停在出院前的试点研究。该暂停针对管理的关键要素（例如，持续时间）进行设计和实施，使用迭代循环和快速反馈。我们使用混合方法评估与可行性相关的实施结果，包括可用性、依从性和可接受性。使用逻辑回归模型，控制患者特征，评估干预组与对照组在出院时干预前后抗生素的使用情况。
药剂师进行了 288 次抗生素暂停。暂停是可行的（每次暂停平均 2.5 分钟）且可接受（85%[40/48]的住院医师认为暂停改善了处方）。药剂师在 25%（73/288）的暂停中建议更改抗生素，其中 70%（51/73）的建议更改被住院医师接受。依从性的障碍包括意外和周末出院。与对照组服务相比，干预期间出院后的抗生素使用没有差异。
在出院时由药剂师协助的抗生素暂停是可行的，并有望成为改善出院时抗生素使用的方法。
