Author: Jackie Harris, PharmD, BCPSExecutive Director of MSHP R&E Foundation/St. Louis College of Pharmacy/Christian Hospital Northeast
At the MSHP/ICHP Spring Meeting, the R&E Foundation presented Journey McCarty, Pharm.D. with the MSHP Best Practice Award for her project entitled “Implementing a Pharmacist Driven 72-hour Antimicrobial Time Out”. The University of Missouri Health Care System implemented a pharmacist driven 72 hour antimicrobial time out in patients receiving vancomycin, ertapenem, meropenem, micafungin, or posaconazole. The primary outcome was days of therapy per 1000 patient days. Secondary outcomes included number and type of interventions, number and percentage of interventions accepted by physicians, time reported by pharmacist to complete antibiotic time out, and percentage of Antibiotic Time Out alerts completed. The pharmacy workflow developed can be seen in Figure 1. Pharmacist training was completed which included the development of a job aid, inservice trainings, a competency assessment, required completion of an online continuing education program on optimizing antimicrobial therapy, and a quality improvement check.
As of March 11th, 153 antibiotic time out forms had been completed with the majority being completed for vancomycin. Interventions were made in 36 of those forms. The majority of the interventions made were for de-escalation of antibiotics (16/36). Other interventions included recommending to discontinue therapy (12/36), recommending a stop date or duration added to order (5/36), dose change (2/36), and recommending to broaden therapy (2/36). Sixty-nine percent of those recommendations were accepted by the physician. An additional 11% of the recommendations were accepted with modifications. For the majority of pharmacists, the form was completed within 5 minutes (79%). The days of therapy per 1000 patient days has been lower each month for vancomycin when comparing January, February, and March of 2019 to 2018. Additionally, the days of therapy per 1000 patient days was lower in February for ertapenem compared with February of 2018.
This project has been well received at the University of Missouri Health Care, and can certainly be implemented at other hospitals throughout the state. The project team continues to identify opportunities for improvement, and is making plans to add more antibiotics to the Antibiotic Time Out in the near future. The team is working towards adding fidaxomicin, daptomycin, and amphotericin B to the Antibiotic Time Out. If you have any questions about how Dr. McCarty implemented her project, please email her at firstname.lastname@example.org.