ANTIBIOTIC TIMEOUTS
The antibiotic timeout is intended to promote critical thinking about whether or not continuation of broad-spectrum antimicrobial therapy is indicated 48-72h into its course. By reviewing clinical dashboard data and completing a templated progress note to determine the appropriateness of broad-spectrum therapy, you will be able to gain automatic approval of continuation of therapy for up to 4 more days without having to contact ID. However, ID approval will be required for all continuations beyond this initial period of automatic renewal.

ADJUSTING ANTIMICROBIAL THERAPY DURING A TIMEOUT
Antimicrobial therapy is often initiated based on suspicion of the presence of infection without knowledge of the identity of the responsible micro-organism (pathogen). An Antibiotic Timeout offers the opportunity to modify therapy based upon the clinical course of the patient and preliminary and/or final microbiology results. This information may lead to one of the following assessments:

  • An infection requiring antibiotic therapy is no longer present. For example, the patient may be found to have an exacerbation of CHF rather than pneumonia or venous stasis rather than cellulitis.

  • The patient may have clinically improved to such an extent that PO can be substituted for IV (see Switching from IV to PO)

  • The infecting microbe may be susceptible to an antibiotic that has a more narrow spectrum or activity (with less risk of facilitating the emergence of further antibiotic resistance) and/or a less toxic antibiotic.

  • The infecting microbe may be resistant to the initially selected therapy and require a change in therapy to an antibiotic with enhanced activity.

CLINICAL DASHBOARD
You may access the clinical dashboard data and view them for all of your patients (NOTE: You must be logged on to your computer with your own Windows VHA login). 

First time users will be prompted to click on a link to register for approval to view clinical dashboards.  For UCLA residents, please list Christopher Graber as your supervisor and only request access for Greater Los Angeles HCS, with the reason for PII/PHI access “clinical care”.

For users already registered, clinical dashboards can be accessed from the homepage. Using the drop-down windows on the right side of the screen, you will be able to select a list of patients that will be retained the next time you access the dashboards.  The dashboard reports can be exported to different formats (PDF works best) under the Actions tab and printed out for clinical purposes.

IMPLEMENTATION GUIDANCE

QUESTIONS
Contact Christopher Graber (Christopher.Graber@va.gov)