Journal
AMERICAN JOURNAL OF INFECTION CONTROL
Volume 50, Issue 7, Pages 777-786Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.ajic.2021.11.016
Keywords
Antimicrobial stewardship; Quality improvement; Implementation science; Health transition; Mixed methods research
Funding
- University of Michigan Department of Internal Medicine Faculty Quality Improvement Award
- BD
- Agency for Healthcare Research and Quality [K08HS026530]
- Department of Veterans Affairs, Health Services Research and Development Service [RCS 11-222]
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This pilot study aimed to assess the feasibility and effectiveness of a pharmacist-facilitated antibiotic timeout prior to discharge in improving antibiotic use. The results showed that this method was feasible and holds promise in improving antibiotic prescribing at hospital discharge.
Background: 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. Methods: 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. Results: 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. Conclusions: A pharmacist-facilitated antibiotic timeout at discharge was feasible and holds promise as a method to improve antibiotic use at discharge. (c) 2021 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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