SCAN: A novel approach for vancomycin time-out

Manigaba, Kayihura; Borgert, Samuel J.; Klinker, Kenneth P.; Cherabuddi, Kartikeya; Venugopalan, Veena

doi:10.1017/ice.2018.249

Cited by 4 publications

(14 citation statements)

References 6 publications

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“…A previous study demonstrated that the efficacy of pharmacist-led time-out was augmented by a more informative approach, such as providing culture results and allergy information to inpatient providers at time-out intervention. [ 16 ]. Another study showed that a team-based, pharmacist-led, time-out strategy using an algorithm potentially promotes oral antimicrobial use [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although both clinical pharmacists and infectious disease (ID) physicians are key providers of ASPs, the difference in the efficacy of antimicrobial time-out led by the respective parties has rarely been investigated [ 14 ]. Moreover, there are only a few studies assessing the efficacy of the time-out strategy for vancomycin use [ 12 , 15 , 16 ]. The present study aimed to investigate the impact of time-out on vancomycin use and to compare the efficacy of antimicrobial time-out between different types of provider (pharmacist vs ID physician) and patient groups (medicine vs surgery/critical care).…”

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confidence: 99%

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

Hasegawa

Tagashira

Murakami

et al. 2021

Open Forum Infectious Diseases

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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.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Hasegawa

Tagashira

Murakami

et al. 2021

Open Forum Infectious Diseases

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“…4 Similarly the Infectious Diseases Society of America (IDSA) recommends "the use of strategies (e.g., antibiotic time-outs, stop orders) to encourage prescribers to perform routine review of antibiotic regimens to improve antibiotic prescribing." 5 Despite the presence of these recommendations, evaluations of a systematic ATO process remain very limited [6][7][8][9][10][11][12] and neither TJC nor IDSA offer guidance on who should perform this evaluation or how it should be conducted and documented. Previous ATO descriptions have primarily been prescriber-driven and have utilized checklists, questionnaires, and face-to-face prompts to conduct the timeout evaluation.…”

Section: Introductionmentioning

confidence: 99%

“…Previous ATO descriptions have primarily been prescriber-driven and have utilized checklists, questionnaires, and face-to-face prompts to conduct the timeout evaluation. [6][7][9][10][11] Pharmacist involvement in ATO has been less commonly described but has been reported to support the re-evaluation of targeted therapies such as vancomycin and piperacillin/tazobactam. 7,11 Even with a robust multidisciplinary ASP and proactive medication review ingrained into the clinical pharmacists' daily activities, we believed there was an opportunity to further improve the consistency of antibiotic therapy assessment and documentation in a sustainable manner.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][9][10][11] Pharmacist involvement in ATO has been less commonly described but has been reported to support the re-evaluation of targeted therapies such as vancomycin and piperacillin/tazobactam. 7,11 Even with a robust multidisciplinary ASP and proactive medication review ingrained into the clinical pharmacists' daily activities, we believed there was an opportunity to further improve the consistency of antibiotic therapy assessment and documentation in a sustainable manner. As pharmacists possess a distinct knowledge of antimicrobials, are familiar with infectious disease syndromes, and serve as integral members of the inpatient health care team, an opportunity exists for pharmacists to engage in the routine assessment of antimicrobial therapy.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a Systematic Pharmacist-Initiated Antibiotic Time-Out Intervention for Hospitalized Adults

Paulson

Handley

Dilworth

et al. 2020

Journal of Pharmacy Practice

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Introduction: 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. Methods: 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. Results: 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%, p<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, p = 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; p = 0.0140). Discussion: 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.

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Impact of the sequential implementation of a pharmacy-driven methicillin-resistant Staphylococcus aureus (MRSA) nasal-swab ordering policy and vancomycin 72-hour restriction protocol on standardized antibiotic administration ratio (SAAR) data for antibiotics used for resistant gram-positive infections

Pettit,

Nguyen,

Lew

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: Vancomycin is often initiated in hospitalized patients; however, it may be unnecessary or continued for longer durations than needed. Oversight of all vancomycin orders may not be feasible with widespread prescribing and strategies to enlist other clinicians to serve as stewards of vancomycin use are needed. We implemented 2 sequential interventions: a protocol in which the pharmacist orders MRSA nasal swab followed by a protocol requiring approval from pharmacists to continue vancomycin for >72 hours. Methods: In this single-center, retrospective, quasi-experimental study, we evaluated vancomycin use after implementation of a pharmacy-driven MRSA nasal-swab ordering protocol and a vancomycin 72-hour restriction protocol. The primary outcome was the change in the standardized antibiotic administration ratio (SAAR) for antibacterial agents for resistant gram-positive infections. We also evaluated the impact on antibiotic utilization. Results: Following the MRSA swab protocol, the SAAR decreased from 1.26 to 1.13 (P < .001; 95% confidence interval [CI], 1.16–1.25). After the 72-hour approval process, the SAAR was 0.96 (P < .001; 95% CI, 1.0–1.12). Vancomycin utilization decreased from 138.9 to 125.3 days of therapy per 1,000 patient days following the MRSA swab protocol (P < .001) and to 112.7 (P < .001) following the 72-hour approval protocol. Interrupted time-series analysis identified a similar rate of decline in utilization following the 2 interventions (−0.3 and −0.5; P = .16). Both interventions combined resulted in a significant reduction (−1.5; P < .001). Conclusion: Implementation of a pharmacist-driven MRSA nasal-swab ordering protocol, followed by a 72-hour approval protocol, was associated with a significant reduction in the SAAR for antibiotics used in the treatment of resistant gram-positive infections and a reduction in vancomycin utilization. Leveraging the oversight of primary service clinical pharmacists through these protocols proved to be an effective strategy.

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SCAN: A novel approach for vancomycin time-out

Cited by 4 publications

References 6 publications

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

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

Impact of a Systematic Pharmacist-Initiated Antibiotic Time-Out Intervention for Hospitalized Adults

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