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10.1310/hpj5011-1011

http://scihub22266oqcxt.onion/10.1310/hpj5011-1011
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C4750836!4750836!27621509
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suck abstract from ncbi


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pmid27621509      Hosp+Pharm 2015 ; 50 (11): 1011-24
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  • Taking an Antibiotic Time-out: Utilization and Usability of a Self-Stewardship Time-out Program for Renewal of Vancomycin and Piperacillin-Tazobactam #MMPMID27621509
  • Graber CJ; Jones MM; Glassman PA; Weir C; Butler J; Nechodom K; Kay CL; Furman AE; Tran TT; Foltz C; Pollack LA; Samore MH; Goetz MB
  • Hosp Pharm 2015[Nov]; 50 (11): 1011-24 PMID27621509show ga
  • Background:: Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation. Objective:: We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval. Methods:: The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign. Results:: In the first 6 months of program implementation, vancomycin was discontinued by day 5 in 93/145 (64%) courses where a time-out was performed on day 4 versus in 96/199 (48%) 1 year prior (P = .04). Seven vancomycin continuations via template (5% of time-outs) were guideline-discordant by retrospective chart review versus none 1 year prior (P = .002). Piperacillin-tazobactam was discontinued by day 5 in 70/105 (67%) courses versus 58/93 (62%) 1 year prior (P = .55); 9 continuations (9% of time-outs) were guideline-discordant versus two 1 year prior (P = .06). A usability survey completed by 32 physicians demonstrated modest satisfaction with the overall program, antimicrobial dashboard, and renewal templates. Conclusions:: By providing practitioners with clinical informatics support and guidance, the intervention increased provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances wherein they previously sought authorization for continuation from an antimicrobial steward.
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