Zachary Willis, MD, MPH was named an Institute for Healthcare Quality Improvement (IHQI) Improvement Scholar for the 2018-19 period. He will implement antibiotic time-outs at Hillsborough Hospital, which is a part of UNC Medical Center. Willis is Director of Pediatric Antimicrobial Stewardship for the Carolina Antimicrobial Stewardship Program.
Antibiotic time-outs are formal reassessments of antimicrobials prescribed to patients under the care of a clinical team. Time-outs typically take place two to three days following the start of antimicrobial treatment. A time-out provides a structured “pause”: the healthcare provider takes new information into account–such as results from blood or urine cultures and how the patient is responding to the drug — and decides if adjustments are needed to the drug, dose, duration, or delivery. For example, drugs can be selected to more precisely target the organism identified in a culture, discontinued if the patient is not found to have an illness that will respond to antimicrobials after all, or changed from IV to oral delivery. Sometimes, a time-out confirms that no change is needed.
Evidence shows that time-outs are a useful tool to ensure patients receive optimal antimicrobial treatment and helps reduce unnecessary, redundant, or longer-than-needed antimicrobial use. While these drugs can be a life-saving tool, their misuse contributes to the growing global public health problem of antimicrobial resistance. To preserve the effective life-span of antimicrobial drugs, it is hoped that interventions such as antibiotic time-outs will help to combat resistance as a part of wider antimicrobial stewardship efforts.