Antibiotic "Time outs"
Improving the use of antibiotics is an important patient safety issue. The Joint Commission’s new Medication Management standard MM.09.01.01, effective January 1, 2017, requires accredited hospitals and critical access hospitals to address antimicrobial stewardship. As part of this new standard, TJC recommends that organizations’ antimicrobial stewardship program be based upon the Centers for Disease Control and Prevention’s “Core Elements of Hospital Antibiotic Stewardship Programs.'
According to the CDC, antibiotics are often started empirically in hospitalized patients while diagnostic information is being obtained. However, providers often do not revisit the selection of the antibiotic after more clinical and laboratory data (including culture results) become available. An antibiotic “time out” prompts a reassessment of the continuing need and choice of antibiotics when the clinical picture is clearer and more diagnostic information is available.
The CDC recommends that all clinicians perform a review of antibiotics 48 hours after antibiotics are initiated to answer these key questions:
- Does this patient have an infection that will respond to antibiotics?
- Laboratory data will inform the answer to this question
- If so, is the patient on the right antibiotic(s), dose, and route of administration?
- Can a more targeted antibiotic be used to treat the infection (de-escalate)? How long should the patient receive the antibiotic(s)?
The antibiotic time out allows the clinician a moment to pause and reassess antibiotic therapy. Because it is conducted when laboratory results are available clinicians will have a fuller clinical picture and can adjust antibiotic therapy as needed.
Included with today’s notice is an example policy about antibiotic “time-outs”.
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