243. Prioritization of Antibiotic Administration for STAT Orders in the Septic Patient: A Retrospective Analysis

Abstract

Background

Appropriate antibiotic (AB) therapy is crucial in sepsis and septic shock. Two central factors govern patient survival: adequate empiric coverage and rapid initiation of therapy. The administration of broad-spectrum antibiotics in sepsis and septic shock play an important role diminishing patient morbidity and mortality.¹ The sequence of antibiotic administration has been suggested to affect patient outcomes.²

Methods

This is a retrospective study to assess the impact of a pictogram (Figure 1) in the emergency department medication rooms on nurses’ antibiotic administration order in the septic patient. The study population included patients prescribed at least two concomitant AB between January 2017 and January 2018. Each patient’s AB regimen, indication and administration sequence were reviewed using a standardized form. Sequence of administration was deemed appropriate if the sequence followed the pictogram: broad to narrower spectrum AB, and was deemed inappropriate if the sequence differed from the pictogram. Ethics approval was obtained before starting the chart review.

Results

A total of 120 patients were identified pre-/postintervention. 20% (10/51) had received AB in an incorrect sequence prior to the pictogram implementation compared with 11% (8/70) postintervention. AB prescribed were piperacillin/tazobactam (24%), azithromycin (24%) and vancomycin (18%), ceftriaxone (15%) for sepsis arising from pneumonia, urinary tract, and intra-abdominal infections.

Conclusion

The availability of a pictogram to guide the sequence of antibiotic administration in the septic patient can assure its correct administration sequence and potentially affect patient outcomes. An improvement (45%,P = 0.2) was seen post implementation suggesting the pictogram to be a helpful visual aid for nurses. Although not statistically significant, the difference implies a tendency that may be explored in a larger sample size to search for a potential effect.

References

1. Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2016. Crit Care Med 2017(45)486–552.

2. Roberts R, et al. Impact of Antibiotic Initiation Sequence on Outcomes in Patients with Septic Shock. Poster 652. Crit Care Med 2016(44) Suppl.

Disclosures

All authors: No reported disclosures.

Session: 51. Antimicrobial Stewardship: Interventions to Improve Outcomes

Thursday, October 4, 2018: 12:30 PM