Table 1.

Overview of Included Studies

Reference	Study Design	Time Period	Sample Size (total)	Patient Population	Comparator Group	Bundle Elements (Intervention Group)	Specific Pharmacist Intervention & Associated Activities
Sarani et al. 200819	Retrospective	2006–2007	62	Hospital wards with rapid response activation in tertiary care, academic medical center	Patients with ‘STAT’ antibiotics without a MET activation	MET activation including: critical care nursing coordinator, respiratory therapist, clinical pharmacist (includes 24 hours per day coverage), and lead physician	1) MET pharmacist verifies verbal antibiotic orders at bedside, notifies the pharmacy, retrieves antibiotics, and hand delivers to bedside nurse 2) Assists with drug selection, dosing, and drug interactions
LaRosa et al. 201216	Prospective cohort	2009	58	Tertiary care, urban, teaching hospital (performed in single ICU)	Patients in whom an overhead sepsis alert was not triggered	Patients meeting criteria on screening tool triggered an overhead alert that brought responders to the bedside – including the ICU physician, ICU nurse, respiratory therapist, and pharmacist – to implement sepsis resuscitation and management bundle elements using a standardized order set	Paged to bedside to work with response team on sepsis resuscitation and bundle elements
Flynn et al. 201414	Retrospective	2008–2011	108	Tertiary care academic medical center (wards, ED, and ICU)	Historical comparison based on DRG codes	Included electronic order sets, deployment of pharmacy and nursing personnel to bedside, and placement of sepsis carts around hospital stocked to facilitate resuscitation	1) Pharmacy resident on-call responds to bedside, evaluates case with team to optimize antibiotic selection and dosing, and assists with preparation, acquisition, and administration of antibiotics in collaboration with nursing 2) Reviews fluid resuscitation, vasopressor selection, and corticosteroid candidacy
Beardsley et al. 201612	Retrospective	2012	283	Tertiary care academic medical center (non-critical care units)	Historical comparison (prior to Code Sepsis initiative)	Code Sepsis activated by rapid response nurse, including: inpatient pharmacy, respiratory, blood gas laboratory, and ICU triage nurse response	1) Pharmacist to call nursing unit 15 minutes after Code Sepsis activation if no antibiotics ordered 2) Protocol for pharmacist to select antibiotics if provider engaged in other aspects of care 3) Implementation of “Code Sepsis” verbal hand-offs at critical junctures of antibiotic ordering and delivery
Moussavi et al. 201618	Retrospective	2014	186	ED of university teaching hospital	No pharmacist present in ED	Presence of a clinical pharmacist in the ED	1) ED clinical pharmacist and technician physically present daily from 0900–1930 2) Numerous responsibilities of ED pharmacist, not limited to evaluating medication orders and facilitating medication preparation and delivery
Laine et al. 201815	Retrospective	2012–2014	76	Tertiary care academic medical center	No comparator group	Included electronic order sets, and deployment of pharmacy and nursing personnel to bedside (evaluation limited to septic shock patients)	1) Pharmacy resident on-call responds to bedside, evaluates case with team to optimize antibiotic selection and dosing, and assists with preparation, acquisition, and administration of antibiotics in collaboration with nursing 2) Reviews fluid resuscitation, vasopressor selection, and corticosteroid candidacy
Chanas et al. 201913	Prospective cohort	2016–2017	161	Surgical/trauma/burn ICU of tertiary care academic medical center	Historical standard of care without BPA to provider	Electronic BPA for septic shock offered provider option to page medical residents, clinical pharmacist, and charge nurse to bedside to review case and facilitate care	Pharmacist reports to bedside with team to assist with antibiotic selection and facilitate administration in collaboration with nursing
MacMillan et al. 201917	Retrospective	2015–2016	160	Medical ICU of a community teaching hospital	Historical standard of care prior to implementation of quality improvement initiative	If sepsis suspected based on electronic and/or manual assessment, charge nurse activated an overhead alert which sent verbal pages to supervising resident physician, critical care pharmacist, and phlebotomist, all of whom were expected to report to bedside within 15 minutes for group consultation.	Pharmacist expected at bedside within 15 minutes of alert to work with physician to order appropriate antibiotics and facilitate preparation/delivery to bedside nurse
Yarbrough et al. 201921	Prospective, two-arm, parallel design	2017	80	ED of a quaternary community hospital	Sepsis alerts without a pharmacist present	Sepsis alert generated once patient meets criteria and multidisciplinary sepsis alert team paged to patient’s room, including the pharmacist	Pharmacist reports to patient’s room, reviews patient’s medical history, and uses a standardized checklist and empiric antibiotic guide to make recommendations and ensure bundle completion
Tarabichi et al. 202220	Randomized, controlled, quality improvement initiative	2019	598	ED of academic, safety-net health care system	Standard sepsis care	Sepsis care augmented with EWS, which included notification on ED patient tracking tool and message sent to ED pharmacist	Pharmacist (available daily from 1000–2100) reviews chart, huddles with ED provider, and facilitates timely and appropriate blood work and fluid/antibiotic administration

BPA = best-practice advisory; DRG = diagnosis-related group; ED = emergency department; EWS = Early warning system; ICU = intensive care unit; MET = medical emergency team.