Original Research
Sunday, October 13, 2024
12:45 PM–02:15 PM
Abstract
Introduction: Delays in antibiotic administration are associated with increased mortality in patients with septic shock.
Research Question or Hypothesis: What are the root causes of antibiotic administration delays in patients with sepsis?
Study Design: Cross-sectional study aimed to identify targeted interventions to improve antibiotic administration times in patients with sepsis.
Methods: An IRB-approved cohort study included a retrospective phase with a random sample of adults receiving systemic antibiotics for sepsis at a community teaching hospital from May 1, 2023, to January 31, 2024. Data collected covered antibiotic order entry, verification, preparation, and administration to assess compliance to the hospital's guideline of antibiotic administration within one hour of order entry. Based on identified barriers, interventions were implemented to optimize antibiotic administration from February 2 to April 28, 2024. The impact of these interventions was assessed using time-series analysis with ARIMA modeling.
Results: Retrospectively, 269 orders showed 64% compliance within one hour, primarily using piperacillin/tazobactam (56%) and cefepime (17%). The emergency department (ED) managed 83% of orders, with critical care units handling 5%. Mean time to administration was 69 minutes, with delays in critical care preparation and delivery, and in ED administration. To improve efficiency, piperacillin/tazobactam was added to critical care dispensing cabinets in February 2024, and ED leadership emphasized timely administration in April 2024. Prospective evaluation of 83 orders showed piperacillin/tazobactam (53%) and cefepime (23%) remained common, with ED managing 81% and critical care 6%. Critical care administration time for piperacillin/tazobactam reduced from 90 to 74 minutes. Overall mean administration time decreased from 69 to 54 minutes, varying by verification, preparation, delivery, and administration times. However, these changes were not directly linked to the interventions per interrupted time series analysis.
Conclusion: Compliance with the hospital guidelines for antibiotic administration in patients with sepsis can be optimized. Next steps include timely inpatient interventions using "code sepsis" alerts and continued interdisciplinary collaboration.
Presenting Author
Asad Ghani PharmDRobert Wood Johnson University Hospital Somerset
Authors
Luigi Brunetti PharmD, PhD
GwangYee Hu PharmD
Robert Wood Johnson University Hospital Somerset
Juanqin Wei PharmD
Robert Wood Johnson University Hospital Somerset