Gill Meghan, Raghu Vikram, Ferguson Elizabeth, Marcinick Adrienne, Rosen Johanna, Butler Gabriella, Horvat Christopher, Crowley Kelli
Department of Pharmacy (EF, KC, MG), UPMC Children's Hospital of Pittsburgh.
Department of Pediatrics (VR, JR), UPMC Children's Hospital of Pittsburgh, PA.
J Pediatr Pharmacol Ther. 2023;28(1):55-62. doi: 10.5863/1551-6776-28.1.55. Epub 2023 Feb 3.
Sepsis causes morbidity and mortality in pediatric patients, but timely antibiotic administration can improve sepsis outcomes. The pharmacy department can affect the time from order to delivery of antibiotics. By evaluating the pharmacy process, this study aimed to decrease the time from antibiotic order to delivery to within 45 minutes.
All antibiotic orders placed following a positive sepsis screen for acute care patients at a freestanding children's hospital from April 1, 2019, to December 31, 2019, were reviewed. Lean Six Sigma methodology including process mapping was used to identify and implement improvements, including educational interventions for providers. Outcome measures included time from antibiotic order placement to delivery and to administration. Additional assessment of process measures included evaluation of order priority, PowerPlan (an internally created order set) use, and delivery method.
Ninety-eight antibiotic orders for 85 patients were evaluated. In an individual chart of antibiotic delivery time, a trend towards faster delivery time was observed after interventions. Stat orders (40.5 minutes [IQR, 19.5-48]) were delivered more quickly than routine orders (51 minutes [IQR, 45-65]; p < 0.001). Orders using the PowerPlan (20.5 minutes [IQR, 18.5-38]) were delivered more quickly than those that did not (47 minutes [IQR, 34-64]; p < 0.01). Shorter time to administration was observed with pneumatic tube delivery (41 minutes [IQR, 20-50]) than with direct delivery to a health care provider (51 minutes [IQR, 31-83]; p < 0.05) or to the automated dispensing cabinet's refrigerator (47 minutes [IQR, 41-62]; p < 0.0001).
Multifactorial coordinated interventions within the pharmacy department improve medication delivery time for pediatric sepsis antibiotic orders.
脓毒症可导致儿科患者发病和死亡，但及时给予抗生素可改善脓毒症的治疗结果。药剂科可影响从开具医嘱到抗生素送达的时间。通过评估药房流程，本研究旨在将从开具抗生素医嘱到送达的时间缩短至45分钟以内。
对2019年4月1日至2019年12月31日期间在一家独立儿童医院对急性护理患者进行脓毒症筛查呈阳性后开具的所有抗生素医嘱进行审查。采用包括流程映射在内的精益六西格玛方法来识别和实施改进措施，包括对医护人员的教育干预。结果指标包括从开具抗生素医嘱到送达以及到用药的时间。对流程指标的额外评估包括医嘱优先级评估、PowerPlan（内部创建的医嘱集）的使用情况以及送达方式。
对85例患者的98份抗生素医嘱进行了评估。在一份抗生素送达时间的个体图表中，干预后观察到送达时间有加快的趋势。急诊医嘱（40.5分钟[四分位间距，19.5 - 48]）比常规医嘱（51分钟[四分位间距，45 - 65]）送达更快（p < 0.001）。使用PowerPlan的医嘱（20.5分钟[四分位间距，18.5 - 38]）比未使用的医嘱（47分钟[四分位间距，34 - 64]）送达更快（p < 0.01）。与直接送达医护人员（51分钟[四分位间距，31 - 83]；p < 0.05）或送达自动配药柜冰箱（47分钟[四分位间距，41 - 62]；p < 0.0001）相比，气动管道送达的用药时间更短（41分钟[四分位间距，20 - 50]）。
药剂科内的多因素协调干预可改善儿科脓毒症抗生素医嘱的用药送达时间。
