Antibiotic timeouts: Pharmacists lead bold antimicrobial stewardship strategy at two large hospitals

Efforts at two large hospitals provide insight

Effective January 2017, Joint Commission–accredited hospitals are now required to have an antimicrobial stewardship program in place. CMS also expressed its intent to require antimicrobial stewardship as a criterion going forward for hospitals to participate in Medicare.

In response, pharmacists at a group of Northwestern Medicine hospitals in Illinois led an antimicrobial therapy timeout initiative as part of their overall strategy to improve antibiotic use and address the widespread issue of antibiotic resistance in the United States.

The program was assessed for a 6-month period, and results showed that pharmacist-recommended interventions were accepted by physicians 97% of the time. (The findings were presented at an IDWeek conference in October 2016.) There were 443 recommendations for 1,674 patients during the study period. 

“It showed us that the stewardship program efforts are being accepted by the physicians, and they are for the most part on board with our goals,” Radhika Polisetty, PharmD, BCPS, clinical and infectious disease pharmacist at Central DuPage Hospital, told Pharmacy Today. Including 333-bed Central DuPage Hospital, the other Northwestern Medicine hospitals that participated were 159-bed Delnor, 98-bed Kishwaukee, and 24-bed Valley West.

The majority of pharmacist-initiated interventions included discontinuing antimicrobial therapy and changing the treatment duration. The pharmacists’ interventions also included switching patients from I.V. to oral therapy and using a narrower-spectrum antibiotic.

CDC defines antibiotic timeouts as a formal point that “prompts a reassessment of the continuing need and choice of antibiotics when the clinical picture is clearer and more diagnostic information is available.”

While CDC recommends that the review be performed 48 hours after antibiotics are initiated, pharmacists at the participating Northwestern Medicine hospitals decided the waiting period would instead be 72 hours because that is the turnaround time for cultures in their lab (as it is in many labs).

Pharmacists at the 650-bed University of Nebraska Medical Center also initiated an antimicrobial therapy timeout clinical initiative and research project, starting with implementation on their academic medicine teams.

“This allows us to work closely with a smaller group of physicians and pharmacists who are able to provide meaningful feedback about the process,” said Kiri Rolek, pharmacist coordinator for antimicrobial stewardship at University of Nebraska Medical Center. “This way we’ll be able to see what works and what doesn’t and make any changes before implementing the process more broadly.”

Like Northwestern Medicine, University of Nebraska Medical Center chose to have pharmacists as the driver of the program because pharmacists consistently work on the same teams. But Rolek said it’s important to have everyone on the medical team understand the rationale for doing timeouts and to support the program.

“It really is a group effort and works best with a multidisciplinary approach,” said Rolek.

Visit www.pharmacytoday.org for the full article in the upcoming February 2017 issue of Pharmacy Today.