Interdisciplinary Team Pilot to Reduce Time to Administration of Piperacillin/Tazobactam in the Emergency Department at a Veterans Affairs Medical Center.

Abstract

Background: Sepsis is a condition of life-threatening organ dysfunction caused by a dysregulated host response to an infection. Adults with suspected sepsis or possible septic shock should receive antimicrobials within 1 hour. Early administration of antibiotics to patients with sepsis has been shown to decrease in-hospital mortality. Factors that affect antibiotic administration time include the antibiotic dispensary location, best practice alerts in electronic medical records, and staff "huddles" to continuously reinforce the importance of antibiotics.

Methods: At our Veterans Affairs Medical Center, we moved piperacillin/tazobactam from the central pharmacy to the emergency department automated dispensing cabinet. We implemented an interdisciplinary sepsis team comprised of emergency medicine (EM) nurses, pharmacists, and physicians. This was a retrospective chart review to assess whether our change in practice affected the time to administration of piperacillin/tazobactam in the emergency department. We assessed whether the change in practice had an effect on mortality in our population.

Results: Patients were reviewed 6 months pre- and post-implantation of the practice changes. There were 139 veterans in the pre-implementation group and 128 in the post-implementation group. The two groups were similar in age, sex, and African-American race. There was a statistically significant reduction in the average time from EM pharmacist verification to nurse administration when comparing the groups (46.5±49.8 vs 30.6±28.7 minutes, p=0.004). There were statistically significant reductions in the time from EM physician recognition to pharmacist order verification (54.37±50.22 vs 40.52±31.26 minutes, p=0.009). Eight patients died in the pre-pilot group compared to five in the post-pilot group. The relative risk of mortality was reduced between the two groups by 32%.

Conclusion: When piperacillin/tazobactam was stocked in the emergency department and we implemented an interdisciplinary sepsis team, there was a significant reduction in the time to administration in patients with sepsis.