Anna Khanina1, Kelly A Cairns2, Steve McGloughlin3, Judit Orosz3, Gordon Bingham3, Michael Dooley4, Allen C Cheng5. 1. Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade Parkville, VIC, 3052, Australia. Electronic address: a.khanina@alfred.org.au. 2. Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. 3. Intensive Care Unit, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia. 4. Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia; Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade Parkville, VIC, 3052, Australia. 5. Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Abstract
BACKGROUND: Sepsis is a medical emergency; timely management has been shown to reduce mortality. We aimed to improve the care of inpatients who developed sepsis after hospital admission by integrating a sepsis bundle with an existing medical emergency team (MET). METHODS: We performed a before-and-after study at an Australian institution. A multimodal intervention was implemented including formation of a working group, development of a guideline, standard documentation, education, audit and feedback. The primary outcome was the proportion of MET calls where there was compliance with the sepsis resuscitation bundle within one hour of MET call. RESULTS: There was an improvement in completion of the entire resuscitation bundle (OR 2.33, 95%, CI: 1.23 - 4.41) and lactate measurement (OR 2.72, CI: 1.53, 4.84) within one hour of MET call. There was a non-significant reduction in the median time to antibiotic administration in patients where antibiotics were initiated or changed at the MET call (60 mins vs. 44 mins, p = 0.8). In hospital mortality was observed to fall from 22.1% to 11.4%, but after adjusting for age and baseline illness severity this differences was not statistically significant (OR 0.52, CI: 0.23, 1.19, p = 0.12). CONCLUSION: The implementation of a multimodal sepsis bundle and the utilisation of an existing MET call system demonstrated an increase in the overall uptake of a sepsis bundle. This was associated with an observed reduction in all-cause in-hospital mortality, although this difference was not statistically significant after adjustment for confounders. Further interventions with a focus on nursing education and engagement may improve timely antibiotic administration.
BACKGROUND:Sepsis is a medical emergency; timely management has been shown to reduce mortality. We aimed to improve the care of inpatients who developed sepsis after hospital admission by integrating a sepsis bundle with an existing medical emergency team (MET). METHODS: We performed a before-and-after study at an Australian institution. A multimodal intervention was implemented including formation of a working group, development of a guideline, standard documentation, education, audit and feedback. The primary outcome was the proportion of MET calls where there was compliance with the sepsis resuscitation bundle within one hour of MET call. RESULTS: There was an improvement in completion of the entire resuscitation bundle (OR 2.33, 95%, CI: 1.23 - 4.41) and lactate measurement (OR 2.72, CI: 1.53, 4.84) within one hour of MET call. There was a non-significant reduction in the median time to antibiotic administration in patients where antibiotics were initiated or changed at the MET call (60 mins vs. 44 mins, p = 0.8). In hospital mortality was observed to fall from 22.1% to 11.4%, but after adjusting for age and baseline illness severity this differences was not statistically significant (OR 0.52, CI: 0.23, 1.19, p = 0.12). CONCLUSION: The implementation of a multimodal sepsis bundle and the utilisation of an existing MET call system demonstrated an increase in the overall uptake of a sepsis bundle. This was associated with an observed reduction in all-cause in-hospital mortality, although this difference was not statistically significant after adjustment for confounders. Further interventions with a focus on nursing education and engagement may improve timely antibiotic administration.
Authors: Zohal Rashidzada; Kelly A Cairns; Trisha N Peel; Adam W Jenney; Joseph S Doyle; Michael J Dooley; Allen C Cheng Journal: JAC Antimicrob Resist Date: 2021-08-27