48–72 Hour "Antimicrobial Time-Out"

Every IV antimicrobial prescription must undergo a formal clinical review within 48-72 hours of initiation, and if continued, at regular 48-72 hour intervals thereafter. This "Time-Out" allows clinicians to reassess the diagnosis using microbiology results and clinical progression.

The CARES Decision Framework

Clinicians must document one of the following five outcomes in the medical notes and on HEPMA:

• C - Cease: Stop antimicrobials if there is no evidence of bacterial infection.
• A - Amend: De-escalate to a narrower spectrum agent or adjust based on culture results.
• R - Refer: Assess suitability for Outpatient Parenteral Antimicrobial Therapy (OPAT). Note that this option is only available for selected indications (SSTI, pyelonephritis [links only active if accessing via NHS network]) in NHS A&A. Access this service through the medical assessment units in Ayr and Crosshouse.
• E - Extend: Continue IV therapy only if clearly indicated (e.g., deep-seated infection) and document the next review date.
• S - Switch: Transition to oral therapy if IVOS criteria are met.

• IV-to Oral Switch (IVOS): Clinical Decision Guide for Ward Rounds