Roberts Russel J, Alhammad Abdullah M, Crossley Lindsay, Anketell Eric, Wood LeeAnn, Schumaker Greg, Garpestad Erik, Devlin John W
Department of Pharmacy, Tufts Medical Center, 800 Washington Street, Box 420, Boston, MA 02111, USA; School of Pharmacy, Northeastern University, 360 Huntington Ave, R218 TF, Boston, MA 02115, USA.
Department of Pharmacy, King Khalid University Hospital, P.O. Box 2457, Riyadh 11451, Saudi Arabia.
Intensive Crit Care Nurs. 2017 Aug;41:90-97. doi: 10.1016/j.iccn.2017.02.002. Epub 2017 Mar 28.
Delays in antibiotic administration after severe sepsis recognition increases mortality. While physician and pharmacy-related barriers to early antibiotic initiation have been well evaluated, those factors that affect the speed by which critical care nurses working in either the emergency department or the intensive care unit setting initiate antibiotic therapy remains poorly characterized.
To evaluate the knowledge, practices and perceptions of critical care nurses regarding antibiotic initiation in patients with newly recognised septic shock.
A validated survey was distributed to 122 critical care nurses at one 320-bed academic institution with a sepsis protocol advocating intravenous(IV) antibiotic initiation within 1hour of shock recognition.
Among 100 (82%) critical care nurses responding, nearly all (98%) knew of the existence of the sepsis protocol. However, many critical care nurses stated they would optimise blood pressure [with either fluid (38%) or both fluid and a vasopressor (23%)] before antibiotic initiation. Communicated barriers to rapid antibiotic initiation included: excessive patient workload (74%), lack of awareness IV antibiotic(s) ordered (57%) or delivered (69%), need for administration of multiple non-antibiotic IV medications (54%) and no IV access (51%).
Multiple nurse-related factors influence IV antibiotic(s) initiation speed and should be incorporated into sepsis quality improvement efforts.
严重脓毒症确诊后抗生素给药延迟会增加死亡率。虽然医生和药房相关的早期抗生素启动障碍已得到充分评估，但在急诊科或重症监护病房工作的重症护理护士启动抗生素治疗的速度受哪些因素影响仍不清楚。
评估重症护理护士对新确诊的感染性休克患者启动抗生素治疗的知识、实践和看法。
向一家拥有320张床位的学术机构的122名重症护理护士发放一份经过验证的调查问卷，该机构有一项脓毒症治疗方案，提倡在休克确诊后1小时内静脉注射抗生素。
在100名（82%）做出回应的重症护理护士中，几乎所有人（98%）都知道脓毒症治疗方案的存在。然而，许多重症护理护士表示，他们会在启动抗生素治疗前先优化血压（使用液体的占38%，同时使用液体和血管加压药的占23%）。快速启动抗生素治疗的沟通障碍包括：患者工作量过大（74%）、不知道已开具（57%）或已送达（69%）静脉用抗生素、需要使用多种非抗生素静脉药物（54%）以及没有静脉通路（51%）。
多个与护士相关的因素会影响静脉用抗生素的启动速度，应将这些因素纳入脓毒症质量改进工作中。
