Chanas Tyler, Volles David, Sawyer Rob, Mallow-Corbett Stephanie
University of Virginia Medical Center, Charlottesville, VA, USA.
J Intensive Care Soc. 2019 Feb;20(1):34-39. doi: 10.1177/1751143718767059. Epub 2018 Mar 29.
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.
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.
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, = 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).
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.
脓毒性休克患者早期使用抗生素可降低死亡率。迅速识别脓毒症并做出反应对于缩短抗生素使用时间至关重要。
在外科重症监护病房引入了一项最佳实践建议，以识别脓毒性休克患者并促进及时采取行动。该最佳实践建议由血培养医嘱和24小时内使用血管活性药物触发。触发警报的护士或医护人员可自动向重症监护病房住院医师、临床药师和护士长发送通知，促使床边响应并进行更密切的评估。纳入2016年5月至2017年3月在外科重症监护病房符合最佳实践建议标准的患者。结果包括24小时内抗生素的变化、对最佳实践建议的反应以及抗生素使用时间。将抗生素使用时间在回顾性干预前期和2016年9月新最佳实践建议发布后定义的为期六个月的前瞻性干预期之间进行比较。数据采用卡方检验、曼-惠特尼U检验和克鲁斯卡尔-沃利斯检验进行分析。
在最佳实践建议实施的前六个月，97例不同患者触发了191次警报。79次最佳实践建议（41%）中发送了警报通知，其中53次（67%）有药师床边响应。83次最佳实践建议（43%）后在24小时内开始使用新抗生素。实施最佳实践建议后抗生素使用时间有缩短趋势（7.4小时对4.2小时，P = 0.057）。与整个队列相比，团队得到通知且药师床边响应时抗生素使用时间更短（4.2小时对1.6小时对1.2小时）。
一项新的最佳实践建议在促使外科重症监护病房脓毒性休克患者快速响应并缩短抗生素使用时间方面有效。团队通知和药师响应与抗生素使用时间缩短相关。
