Richardson Kenneth J, Mullen Chanda L, Sacha Gretchen L, Wasowski Erik M
Department of Pharmacy, Euclid Hospital, Cleveland Clinic, Euclid, OH, USA.
Department of Pharmacy, Cleveland Clinic Main Campus, Cleveland Clinic, Cleveland, OH, USA.
J Pharm Technol. 2024 Dec;40(6):263-268. doi: 10.1177/87551225241283193. Epub 2024 Sep 27.
Prompt treatment of sepsis and septic shock is critical as delays increase mortality risk. Various tools, such as electronic alerts, standardized order sets, and rapid response teams, are used to expedite sepsis bundled care, yet their individual effects on outcomes and antimicrobial timing are unclear. This study evaluated the impact of an Inpatient Code Sepsis protocol, featuring an overhead page and order set, on mortality in hospitalized patients with sepsis and septic shock. A retrospective cohort study was conducted at a 371-bed hospital from July 1, 2020, to July 31, 2023. Hospitalized adults (≥18 years) diagnosed with sepsis and septic shock before and after the Inpatient Code Sepsis protocol implementation were included. The primary outcome was 30-day all-cause mortality; secondary outcomes were hospital length of stay, 30-day readmission, and time to antibiotic administration. Patients were excluded if they were identified for sepsis without infection, had sepsis due to non-bacterial causes, lost to follow-up within 30 days of admission, received empiric antibiotics in an emergency department or outside hospital, or were missing antibiotic administration time. A total of 138 patients were included in the analysis. Mortality within 30 days did not significantly differ preprotocol and postprotocol ( = 0.381). However, a significant reduction in time to antibiotic administration was noted postimplementation ( < 0.05). Hospital length of stay and 30-day readmission showed no significant changes. The Inpatient Code Sepsis protocol did not impact 30-day mortality but did improve the time to antibiotic administration.
及时治疗脓毒症和脓毒性休克至关重要,因为延误治疗会增加死亡风险。各种工具,如电子警报、标准化医嘱集和快速反应小组,被用于加快脓毒症综合治疗,但它们对治疗结果和抗菌药物使用时机的个体影响尚不清楚。本研究评估了一项住院脓毒症代码协议(包括顶页提示和医嘱集)对脓毒症和脓毒性休克住院患者死亡率的影响。2020年7月1日至2023年7月31日,在一家拥有371张床位的医院进行了一项回顾性队列研究。纳入在住院脓毒症代码协议实施前后被诊断为脓毒症和脓毒性休克的成年住院患者(≥18岁)。主要结局是30天全因死亡率;次要结局是住院时间、30天再入院率和抗生素给药时间。如果患者被认定为无感染的脓毒症、非细菌性原因导致的脓毒症、入院后30天内失访、在急诊科或院外接受经验性抗生素治疗或缺失抗生素给药时间,则将其排除。共有138例患者纳入分析。协议实施前和实施后的30天内死亡率无显著差异( = 0.381)。然而,实施后抗生素给药时间显著缩短( < 0.05)。住院时间和30天再入院率无显著变化。住院脓毒症代码协议对30天死亡率无影响,但改善了抗生素给药时间。