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Publication Date

11-6-2017

Keywords

antibiotics, emergency department, sepsis, shock, electronic medical record, pharmacy

Abstract

Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.

Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.

Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the alert, ED pharmacists reviewed the patient profile, including differential diagnosis; antibiotic allergies, reactions and/or previous tolerance; recent bacterial cultures; and any antibiotics already ordered, to assess dose and spectrum of coverage. Pharmacists intervened as needed to ensure patients received appropriate broad spectrum antibiotics. Antibiotics were defined as broad spectrum in the same manner as by the Centers of Medicare and Medicaid Services in its Early Management Bundle, Severe Sepsis/Septic Shock. Education was provided to physicians, nurses and pharmacists to encourage timely administration. Outcomes to be measured include mean time to broad spectrum antibiotics, percentage of patients who received broad spectrum antibiotics within 1 hour of presentation, and percentage of patients who received broad spectrum antibiotics within 3 hours of presentation.

Results: Pre-alert intervention, patients who were coded with the ICD-10 codes for sepsis, severe sepsis or septic shock in May 2016 (n = 65) were analyzed to determine mean time to broad spectrum antibiotics (2.81 ± 1.63 hours), percentage of patients who received broad spectrum antibiotics within 1 hour (3.1%), and percentage of patients who received broad spectrum antibiotics within 3 hours (67.7%). Post-alert outcomes will be reported at Aurora Scientific Day.

Conclusion: To be reported at Aurora Scientific Day.