BACKGROUND: Early administration of antibiotics in septic shock is associated with decreased mortality. Promptly identifying sepsis and eliciting a response are necessary to reduce time to antibiotic administration. METHODS: A best-practice advisory was introduced in the surgical intensive care unit to identify patients with septic shock and promote timely action. The best-practice advisory is triggered by blood culture orders and vasopressor administration within 24 h. The nurse or provider who triggers the alert may send an automatic notification to the intensive care unit resident, clinical pharmacist, and charge nurse, prompting bedside response and closer evaluation. Patients who met best-practice advisory criteria in the surgical intensive care unit from May 2016 through March 2017 were included. Outcomes included changes in antibiotics within 24 h, response to best-practice advisory, and time-to-antibiotics. Time-to-antibiotics was compared between a retrospective pre-intervention period and a six-month prospective post-intervention period defined by launch of the new best-practice advisory in September 2016. Data were analyzed by chi square, Mann-Whitney U, and Kruskal-Wallis. RESULTS: During the first six months of best-practice advisory implementation, 191 alerts were triggered by 97 unique patients. Alert notification was transmitted in 79 best-practice advisories (41%), with pharmacist bedside response in 53 (67%). New antibiotics were started within 24 h following 83 best-practice advisories (43%). There was a trend toward decreased time-to-antibiotics following implementation of the best-practice advisory (7.4 vs. 4.2 h, p = 0.057). Compared to the entire cohort, time-to-antibiotics was shorter when the team was notified and when a pharmacist responded to the bedside (4.2 vs. 1.6 vs. 1.2 hours). CONCLUSIONS: A new best-practice advisory has been effective at eliciting a rapid response and reducing the time-to-antibiotics in surgical intensive care unit patients with septic shock. Team notification and pharmacist response are associated with decreased time-to-antibiotics.
BACKGROUND: Early administration of antibiotics in septic shock is associated with decreased mortality. Promptly identifying sepsis and eliciting a response are necessary to reduce time to antibiotic administration. METHODS: A best-practice advisory was introduced in the surgical intensive care unit to identify patients with septic shock and promote timely action. The best-practice advisory is triggered by blood culture orders and vasopressor administration within 24 h. The nurse or provider who triggers the alert may send an automatic notification to the intensive care unit resident, clinical pharmacist, and charge nurse, prompting bedside response and closer evaluation. Patients who met best-practice advisory criteria in the surgical intensive care unit from May 2016 through March 2017 were included. Outcomes included changes in antibiotics within 24 h, response to best-practice advisory, and time-to-antibiotics. Time-to-antibiotics was compared between a retrospective pre-intervention period and a six-month prospective post-intervention period defined by launch of the new best-practice advisory in September 2016. Data were analyzed by chi square, Mann-Whitney U, and Kruskal-Wallis. RESULTS: During the first six months of best-practice advisory implementation, 191 alerts were triggered by 97 unique patients. Alert notification was transmitted in 79 best-practice advisories (41%), with pharmacist bedside response in 53 (67%). New antibiotics were started within 24 h following 83 best-practice advisories (43%). There was a trend toward decreased time-to-antibiotics following implementation of the best-practice advisory (7.4 vs. 4.2 h, p = 0.057). Compared to the entire cohort, time-to-antibiotics was shorter when the team was notified and when a pharmacist responded to the bedside (4.2 vs. 1.6 vs. 1.2 hours). CONCLUSIONS: A new best-practice advisory has been effective at eliciting a rapid response and reducing the time-to-antibiotics in surgical intensive care unit patients with septic shock. Team notification and pharmacist response are associated with decreased time-to-antibiotics.
Entities:
Keywords:
Sepsis; antibiotics; electronic alert; intensive care unit; septic shock
Authors: Julian Villar; Joseph P Clement; Jim Stotts; Daniel Linnen; David J Rubin; David Thompson; Antonio Gomez; Christopher Fee Journal: Ann Emerg Med Date: 2014-03-27 Impact factor: 5.721
Authors: Anand Kumar; Daniel Roberts; Kenneth E Wood; Bruce Light; Joseph E Parrillo; Satendra Sharma; Robert Suppes; Daniel Feinstein; Sergio Zanotti; Leo Taiberg; David Gurka; Aseem Kumar; Mary Cheang Journal: Crit Care Med Date: 2006-06 Impact factor: 7.598
Authors: Mitchell M Levy; Mitchell P Fink; John C Marshall; Edward Abraham; Derek Angus; Deborah Cook; Jonathan Cohen; Steven M Opal; Jean-Louis Vincent; Graham Ramsay Journal: Crit Care Med Date: 2003-04 Impact factor: 7.598
Authors: Michael A Puskarich; Stephen Trzeciak; Nathan I Shapiro; Ryan C Arnold; James M Horton; Jonathan R Studnek; Jeffrey A Kline; Alan E Jones Journal: Crit Care Med Date: 2011-09 Impact factor: 7.598
Authors: Amber M Sawyer; Eli N Deal; Andrew J Labelle; Chad Witt; Steven W Thiel; Kevin Heard; Richard M Reichley; Scott T Micek; Marin H Kollef Journal: Crit Care Med Date: 2011-03 Impact factor: 7.598
Authors: Anne-Marie J Scheepers-Hoeks; Rene J Grouls; Cees Neef; Eric W Ackerman; Erik H Korsten Journal: Artif Intell Med Date: 2013-06-06 Impact factor: 5.326
Authors: R Phillip Dellinger; Mitchell M Levy; Andrew Rhodes; Djillali Annane; Herwig Gerlach; Steven M Opal; Jonathan E Sevransky; Charles L Sprung; Ivor S Douglas; Roman Jaeschke; Tiffany M Osborn; Mark E Nunnally; Sean R Townsend; Konrad Reinhart; Ruth M Kleinpell; Derek C Angus; Clifford S Deutschman; Flavia R Machado; Gordon D Rubenfeld; Steven A Webb; Richard J Beale; Jean-Louis Vincent; Rui Moreno Journal: Crit Care Med Date: 2013-02 Impact factor: 7.598
Authors: Sean M Bagshaw; Stephen Lapinsky; Sandra Dial; Yaseen Arabi; Peter Dodek; Gordon Wood; Paul Ellis; Jorge Guzman; John Marshall; Joseph E Parrillo; Yoanna Skrobik; Anand Kumar Journal: Intensive Care Med Date: 2008-12-09 Impact factor: 17.440
Authors: Rebecca A Greene; Andrew R Zullo; Craig M Mailloux; Christine Berard-Collins; Mitchell M Levy; Timothy Amass Journal: Crit Care Med Date: 2020-02 Impact factor: 7.598
Authors: Khalia Ackermann; Jannah Baker; Malcolm Green; Mary Fullick; Hilal Varinli; Johanna Westbrook; Ling Li Journal: J Med Internet Res Date: 2022-02-23 Impact factor: 7.076