Matthews Philippa C, Wangrangsimakul Tri, Borthwick Mark, Williams Clare, Byren Ivor, Wilkinson Douglas
Oxford University Hospitals NHS Trust.
BMJ Qual Improv Rep. 2013 Oct 28;2(2). doi: 10.1136/bmjquality.u202241.w1120. eCollection 2014.
Delays in antibiotic therapy in the context of severe sepsis are associated with increased mortality. One way to reduce such delays may be through modifications to electronic prescribing (EP) systems. The research team evaluated the role of one such EP system in reducing delays in antibiotic administration in an Intensive Care Unit (ICU). First, the delays in antibiotic administration in adult ICU patients was quantified. The EP system was then modified to remove deafult time settings for antibiotic doses, which ensured that all antibiotic doses were scheduled for administration within an hour of the prescription being generated. Enhanced training for clinicians and nurses was also implemented, focusing on the EP system and highlighting the importance of prompt antimicrobial prescribing and delivery to the patient. The antibiotic administration was re-audited, and a significant reduction in delays (p=0.002, Mann-Whitney U test) was found. This study demonstrates how prudent use of EP systems can help to reduce delays in antibiotic administration in an ICU setting, thus potentially contributing to reducing mortality in patients with sepsis.
在严重脓毒症情况下，抗生素治疗的延迟与死亡率增加相关。减少此类延迟的一种方法可能是对电子处方（EP）系统进行改进。研究团队评估了一种这样的EP系统在减少重症监护病房（ICU）抗生素给药延迟方面的作用。首先，对成年ICU患者抗生素给药的延迟进行了量化。然后对EP系统进行修改，去除抗生素剂量的默认时间设置，这确保了所有抗生素剂量在处方生成后一小时内安排给药。还对临床医生和护士进行了强化培训，重点是EP系统，并强调及时开具抗菌药物处方并给患者用药的重要性。对抗生素给药情况进行了重新审核，发现延迟显著减少（p = 0.002，曼-惠特尼U检验）。这项研究表明，谨慎使用EP系统有助于减少ICU环境中抗生素给药的延迟，从而有可能降低脓毒症患者的死亡率。
