Background: Sepsis is the leading cause of mortality and extends the length of stay for numerous numbers of hospital patients. Delay in diagnosis and initiation of antibiotics have shown to increase mortality with Sepsis patients. Evidence proved that delay in antibiotic administration decreases survival by almost 12% per hour. Related studies support the effectiveness of prompt administration of first doses of antibiotics in saving patient’s lives and achieving positive outcomes, decreasing mortality, and stopping the further damage that sepsis can cause into more complications.
Purpose: The aim of this evidence-based project is to identify barriers and create interdisciplinary interventions that will improve the turnaround time for first-dose antibiotics administration in a 21-bed acute care, medical unit in an academic center located in southwestern US.
Method: The compliance rate of the medical unit for first-dose antibiotics administration for the first and second quarter of 2021 was a great area of concern for patient safety. The compliance rate set by the hospital infection control was 60% but the medical unit averaged 50-55% for the period of January to August 2021. Methodologies included to achieve improved results in were staff education, 1:1 follow-up with nurses not meeting the time allotted for administering within 60 minutes of order entry, identification of the barriers such as lack of IV access, or the issues of patients out of the room at the time of administration. Interdisciplinary coordination was done with the pharmacy for the availability of the antibiotics if it’s from the Pyxis or central pharmacy, and the addition of more antibiotics into the unit Pyxis. Coordination also happened with the deliveries by courier, making sure first doses are delivered first, and collaboration with the physician when timing of the administration needs to be adjusted if the patients are out for procedures. The unit sepsis champion and the unit educator actively campaigned during huddles and did PowerPoint presentations to remind nurses about the initiative. The unit leadership also created an awareness memo signed by all nurses so accountability is reinforced and objectives were reiterated.
Results: By the third quarter of 2021 and up to April of 2022, the medical unit improved and sustained compliance between 67-78% and was always on the top 5 units of the hospital, with high percentage of first-dose antibiotics turnaround time. It was a feat that seemed to be impossible from the previous first two quarters of 2021, but a lot of teamwork was key. Communication between the nurses and pharmacy department was streamlined and was vital in locating the antibiotics to be delivered, ensuring they were administered on time, and making sure that barriers were addressed.
Conclusion: Focusing on the important interventions to prioritize the safety of our patients can be achieved and is very possible with all the stakeholders doing their part and collaborate as a team. These interventions are now hardwired in our best practices against sepsis.
Evidence-based references 1. Viljay, J., et al.(2020). Factors affecting the time of first dose antibiotic in sepsis and septic shock. Journal of Emergency Medicine 58(4), 716-716. 2. Hutchison, R., et.al.(2011). Improving severe sepsis outcomes, cost, and time to first antibiotic dose. Dimensions of Critical Care 30(5), 277-282