Keul Ryan, Rodriguez Jordan, Coleman Ariel, Yadav Prerna
Texas Children's Hospital, Houston, Tex.
Pediatr Qual Saf. 2020 Jan 22;5(1):e250. doi: 10.1097/pq9.0000000000000250. eCollection 2020 Jan-Feb.
Recommended time to start administration of first dose antibiotics for sepsis patients is 60 minutes from time 0. Institution-specific data revealed that only one-quarter of severe sepsis patients were meeting this goal when measured from the time of provider order entry. Reliance on a pneumatic tube system for first-dose antibiotic delivery was deemed largely responsible for this finding. This project aimed to increase the percentage of pediatric intensive care unit patients with severe sepsis receiving first dose antibiotics within 60 minutes of provider order entry to ≥50%.
Baseline data were collected from May to June 2018 and resulted in the development of a new "antibiotic champion" process, which we piloted for 1 week in early August 2018. The primary outcome measure was the cumulative percentage of patients meeting the 60-minute goal as measured from provider order entry to start of antibiotic administration. A key secondary endpoint was the median time in minutes from provider order entry to antibiotic administration.
We included 14 patients in baseline data analysis and 16 patients in the pilot. The overall percentage of patients receiving antibiotics within 60 minutes of order entry increased from 29% to 75% (-value: 0.026). The median time from provider order entry to antibiotic administration decreased by 36.5 minutes [baseline: 84.5 (range 58.8-117) versus pilot 48 (range 32-65), -value: 0.0017].
The antibiotic champion process significantly increased the total percentage of severe sepsis patients meeting the 60-minute goal and decreased the median time to first-dose antibiotic administration for pediatric intensive care unit patients.
脓毒症患者开始使用首剂抗生素的推荐时间是从时间0起60分钟。机构特定数据显示，从医嘱录入时间开始测量时，只有四分之一的严重脓毒症患者达到这一目标。对气动管道系统用于首剂抗生素输送的依赖在很大程度上被认为是这一结果的原因。该项目旨在将儿科重症监护病房中严重脓毒症患者在医嘱录入后60分钟内接受首剂抗生素治疗的比例提高到≥50%。
2018年5月至6月收集基线数据，并由此开发了一个新的“抗生素倡导者”流程，我们于2018年8月初对其进行了为期1周的试点。主要结局指标是从医嘱录入到开始使用抗生素时达到60分钟目标的患者累积百分比。一个关键的次要终点是从医嘱录入到使用抗生素的中位时间（以分钟为单位）。
我们纳入了14例患者进行基线数据分析，16例患者参与试点。医嘱录入后60分钟内接受抗生素治疗的患者总体比例从29%提高到了75%（P值：0.026）。从医嘱录入到使用抗生素的中位时间减少了36.5分钟[基线：84.5（范围58.8 - 117）对比试点48（范围32 - 65），P值：0.0017]。
抗生素倡导者流程显著提高了达到60分钟目标的严重脓毒症患者的总比例，并缩短了儿科重症监护病房患者首剂抗生素给药的中位时间。
