Sepsis call emergency department pharmacist service: a single healthcare network cohort study

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-07-14 DOI:10.1002/jppr.1931

Iouri Banakh BPharm, MClinPharm, Stephen Louey BPharm, MClinPharm, Graham Rivers BSc, PgD Pharm Practice, Tavan Hem BPharm, Lili Israelian BPharm, Junwon Kang BPharm, Vivienne Luu BPharm, Firuz Tanyeri MBChB, Rachel Rosler MBChB, FACEM

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引用次数: 0

Abstract

Background

Sepsis and septic shock are common emergency department (ED) presentations, with current guidelines recommending early administration of antibiotics to reduce mortality.

Aim

Sepsis calls with pharmacist attendance have been introduced at two EDs, and the aim of this study was to evaluate the impact of this service on outcomes of all septic patients.

Method

At a multisite, single healthcare network, located in Victoria, Australia, emergency medicine pharmacists were trained in assisting medical staff in antibiotic selection, dosing, and delivering antibiotics directly to nursing staff. The sepsis call service was introduced in May 2022 at one site and in March 2023 at another site, with time to first antibiotic administration, morbidity, and mortality being compared to the outcomes of patients from the same EDs from January–April 2022 (group 1). Post the sepsis call introduction, two cohorts were compared: sepsis call attended patients without a pharmacist (group 2) and with a pharmacist (group 3). This project was exempt due to the local policy requirements that constitute research by the Monash Health Human Research Ethics Committee (Reference no: RES-23-0000-237Q). The justification for this ethics exemption was as follows: the study was retrospective, included privacy protections for patients' data, and presented no increased risk to patient care.

Results

The study included 201 patients, with time to first antibiotic administration on average 302.0 min in group 1, 201.3 min (p = 0.007) in group 2, and 89.8 min (p < 0.001) in group 3. Mortality (p = 0.306), rates of acute kidney injury (p = 0.111), intensive care unit (ICU) admission (p = 0.002), and need for dialysis (p = 0.497) were all reduced in group 3. Adherence to antibiotic guidelines was increased in group 3 (p < 0.001).

Conclusion

Emergency medicine pharmacist contribution led to reduced time to first antibiotic, an improved adherence to antibiotic guidelines, and positive trends in secondary clinical outcomes. Further research is required to determine the significance of improvements in mortality, intensive care unit admissions, and renal impairment.

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败血症呼叫急诊科药剂师服务：单一医疗保健网络队列研究

脓毒症和脓毒性休克是急诊科（ED）的常见病，现行指南建议尽早使用抗生素以降低死亡率。在澳大利亚维多利亚州的一个多站点、单一医疗保健网络中，急诊科药剂师接受了协助医务人员选择抗生素、剂量以及直接向护理人员提供抗生素的培训。脓毒症呼叫服务分别于 2022 年 5 月和 2023 年 3 月在一个医疗点和另一个医疗点推出，首次使用抗生素的时间、发病率和死亡率与 2022 年 1 月至 4 月期间同一急诊室患者的结果进行了比较（第 1 组）。脓毒症呼叫引入后，对两个组别进行了比较：没有药剂师参与的脓毒症呼叫患者（第 2 组）和有药剂师参与的患者（第 3 组）。由于当地政策要求构成研究，该项目获得了莫纳什卫生部人类研究伦理委员会的豁免（参考编号：RES-23-0000-237Q）。获得伦理豁免的理由如下：该研究具有回顾性，包括患者数据隐私保护，且不会增加患者护理风险。该研究共纳入 201 名患者，第一组患者首次使用抗生素的平均时间为 302.0 分钟，第二组为 201.3 分钟（p = 0.007），第三组为 89.8 分钟（p < 0.001）。第 3 组的死亡率（p = 0.306）、急性肾损伤率（p = 0.111）、入住重症监护室（ICU）率（p = 0.002）和透析需求（p = 0.497）均有所下降。急诊医学药剂师的贡献缩短了首次使用抗生素的时间，提高了抗生素指南的依从性，并在次要临床结果方面呈现积极趋势。急诊医学药剂师的参与缩短了首次使用抗生素的时间，提高了抗生素指南的依从性，并使次要临床结果呈现积极趋势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.