Optimizing Antimicrobial Therapy with Timeouts

Monday, November 2, 2015, 12:00 AM - Tuesday, October 27, 2020, 12:00 AM PST, Online Course

Internet Enduring Material Jointly Provided by Stanford University School of Medicine (CME) and University of Rhode Island College of Pharmacy. Presented by The Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine

Antibiotic misuse is widespread and has dire patient and public health consequences. National organizations, including the CDC and the Joint Commission, advocate for a formal “Antibiotic Timeout” to reassess empiric antibiotics 48-72 hours after their initiation. During this Timeout, clinicians should answer the following questions:  Does the patient have an infection that will respond to antibiotics?  If so, is the patient on the right antibiotic(s) and is it being administered in the correct dose and by the correct route and (in the case of intravenous therapy) duration of infusion?  Can a more targeted antibiotic regimen be used to treat the infection (i.e., de-escalation)?  For how long should the antibiotic(s) be administered? 

This CME activity provides a practical approach to performing “Antibiotic Timeouts” in the inpatient setting. Using short, didactic sessions, we will provide examples on how to reassess antibiotic therapy started empirically using clinical, laboratory, and microbiological data.  The majority of this CME will be high-yield, interactive inpatient cases covering skin and soft tissue infections, pneumonia, catheter-associated urinary tract infections, and neutropenic fever, that illustrate the timeout process and the principles of appropriate use of antimicrobials.

Intended Audience

This course is designed to meet the educational needs of physicians from a wide variety of specialties including cardiology, critical care, family practice, general surgery, hospitalists, infectious diseases, internal medicine, neurology, oncology, pediatrics, and urology, as well as pharmacists, nurse practitioners, and physician assistants.

  Release Date: November 2, 2015
  Latest Review Date: October 27, 2017
  Expiration Date: October 27, 2020
  Estimated Time to Complete: 2 Hours
  CME Credits Offered: 2.00
  CPE Credits: 2.0 contact hours (0.20 ceus)
  Registration Fee: FREE

Pharmacists wishing to claim ACPE credit must use the procedure outlined below:
Review the information below and complete the entire activity. Complete the Post-test and Evaluation Survey. You must receive a score of 75% or higher on the post-test in order to pass. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.

All participants will have the opportunity to evaluate the educational session and speaker and to identify future educational needs.

A program evaluation must be completed at www.uripharmacycpd.org within 60 days of completing the program in order to receive CE credit.  CE credit will be transferred to the CPE Monitor upon successful completion of the program evaluation. Transfer of CE credit should be verified at mycpemonitor.net where CE statements are available to print. Please refer to the evaluation instructions that follow for completing program evaluations and reporting CE credit.

After you successfully complete the activity, you should email cmeonline@stanford.edu for an activity link to the URI Continuing Professional Development (CPD) Management System at: www.uripharmacycpd.org to complete a program evaluation, claim your ACPE credit, and report your CE participation in the activity


AMA PRA Category 1 Credits™ (2.00 hours), Non-Physician Participation Credit (2.00 hours)

1. Describe the principles and shortcomings of empiric antibiotic therapy.
2. Routinely conduct all steps of the antibiotic timeout, in accordance with CDC guidelines on antibiotic stewardship that include:
3. Analyzing laboratory and clinical data
4. Formulating a rationale for continued antibiotic use
5. Documenting rationale in patient’s electronic medical record
6. Determining the most effective duration of antibiotic therapy
7. Deciding when it is appropriate to switch from an IV to oral route of antibiotic administration

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

<<if Jointly Providership>> In support of improving patient care, this activity has been planned and implemented by Stanford Medicine and . Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 
 

Credit Designation 

American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 2.00 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Accreditation Council of Pharmacy Education (ACPE) 
Stanford Medicine designates this knowledge-based activity for a maximum of [insert number] hours. Credit will be provided to NABP CPE Monitor within 60 days after the activity completion.

American Nurses Credentialing Center (ANCC) 
Stanford Medicine designates this [insert learning format] activity for a maximum of [insert number] ANCC contact hours.  

ASWB Approved Continuing Education Credit (ACE) – Social Work Credit 
As a Jointly Accredited Organization, Stanford Medicine is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Stanford Medicine maintains responsibility for this course. Social workers completing this activity receive [insert number] [insert learning format] continuing education credits. 

American Academy of Physician Assistants (AAPA) - Live 
Stanford Medicine has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This live activity is designated for [insert number] AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.  

American Academy of Physician Assistants (AAPA) - Enduring Materials 
Stanford Medicine has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This enduring activity is designated for [insert number] AAPA Category 1 CME credits. Approval is valid until {Expiration Date}. PAs should only claim credit commensurate with the extent of their participation. 

American Psychological Association (APA) 
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibly for the content of the programs. 

<<For activities with AMA PRA Category 1 Credit and approved for MOC only>>
American Board of Anesthesia MOC Credit 
This activity contributes to the CME component of the American Board of Anesthesiology’s redesigned Maintenance of Certification in Anesthesiology^TM (MOCA®) program, known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements. 

American Board of Internal Medicine MOC Credit 
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to [insert number] MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

American Board of Ophthalmology MOC Credit 
Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to satisfy the Lifelong Learning, Self-Assessment, Improvement in Medical Practice and/or Patient Safety requirements for the American Board of Ophthalmology’s Maintenance of Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting MOC credit.  

American Board of Otolaryngology – Head and Neck Surgery MOC Credit
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn their required annual part II self-assessment credit in the American Board of Otolaryngology – Head and Neck Surgery’s Continuing Certification program (formerly known as MOC). It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of recognizing participation. 

American Board of Pathology MOC Credit
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to [insert number] MOC points in the American Board of Pathology’s (ABPath) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABPathMOC credit.

American Board of Pediatrics MOC Credit 
Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to [insert number] MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.

American Board of Surgery MOC Credit 
Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME and/or Self-Assessment requirements of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit. 

<<For activities with AMA PRA Category 1 Credit and approved for ABIM and ABP combined statement>> 
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to: 
- [insert number] Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program; and
- [insert number] MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. 

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM or ABP MOC credit.

 

Accessibility Statement
 
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.

Cultural and Linguistic Competency

The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: http://lane.stanford.edu/portals/cultural.html

Bibliography

Deresinski S. Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. 2007;45 Suppl 3:S177-83. PMID: 17712744

Oxman DA, Adams CD, Deluke G, et al. Improving antibiotic de-escalation in suspected ventilator-associated pneumonia: an observational study with a pharmacist-driven intervention. J Pharm Pract. 2015;28(5):457-61. PMID: 24651641

Duchene E, Montassier E, Boutoille D, et al. Why is antimicrobial de-escalation under-prescribed for urinary tract infections? Infection. 2013;41(1):211-4. PMID: 23124907

American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. PMID: 15699079

Freifeld AG, Bow EJ, Sepkowitz KA, et al, Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-93. PMID: 21258094

Hooton TM, Bradley SF, Cardenas DD, et al.; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-63. PMID: 20175247

Mandell LA, Wunderink RG, Anzueto A, et al.; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 (Suppl 2):S27-72. PMID: 17278083

Stevens DL, Bisno AL, Chambers HF, et al, Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014; 59(2):e10-52. doi: 10.1093/cid/ciu444. Erratum in: Clin Infect Dis. 2015; 60(9):1448. Dosage error in article text. PMID: 24973422

For a complete list, please view the References/Bibliography page in the Course.

Disclosures

The following planner indicated having relevant relationships with industry to disclose:

Stan Deresinski, MD, FIDSA
Clinical Professor of Infectious Disease
Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Course Director
Bayer & Cubist Pharmaceuticals - Advisory Board Member

 

The following planners, speakers, authors, and reviewers have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Stan Deresinski, MD, FIDSA
Clinical Professor of Infectious Disease
Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Speaker/Author

Marisa Holubar, MD, MS
Clinical Assistant Professor in Medicine, Division of Infectious Disease and Geographic Medicine
Associate Director Stanford Antimicrobial Safety and Sustainability Program
Stanford University School of Medicine
Course Director
Speaker/Author

Elizabeth Robilotti, MD, MPH
Assistant Attending, Infectious Diseases
Associate Director, Infection Control
Memorial Hospital for Cancer and Allied Diseases,
Memorial Sloan Kettering Cancer Center, New York, NY
Course Director
Reviewer

Emily Mui, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Stanford Hospital and Clinics
Planner

Lina Meng, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Stanford Hospital and Clinics
Planner

Arjun Srinivasan, MD (CAPT, USPHS)
Associate Director for Healthcare-Associated Infection Prevention Programs
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Speaker

Kirthana R. Beaulac, PharmD, BCPS
Antimicrobial Stewardship Pharmacist
Tufts Medical Center, Boston, MA
Reviewer

This activity received no commercial support.