Introduction of an emergency medicine pharmacist-led sepsis alert response system in the emergency department: A cohort study.
medicines management
pharmacists
sepsis
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
17
12
2022
received:
20
09
2022
accepted:
19
12
2022
medline:
18
7
2023
pubmed:
13
1
2023
entrez:
12
1
2023
Statut:
ppublish
Résumé
To determine effects of implementing a sepsis alert response system in the ED that included early intervention by emergency medicine (EM) pharmacists. A prospective cohort (8 February 2016 to 28 February 2018) of patients after implementation of a sepsis alert response system in an Australian ED was compared to a retrospective cohort (3 January 2015 to 7 February 2016) of patients with sepsis who presented during EM pharmacist working hours and were admitted to the ICU. There were 184 patients, including 80 patients pre- and 104 patients post-implementation. The post-intervention cohort was triaged at a higher acuity, had higher quick Sepsis-related Organ Failure Assessment (qSOFA) scores and higher initial lactate measurements. After the intervention, antimicrobial agents were administered to patients within 60 min of presentation more often (21 [26.3%] to 85 [81.7%], P < 0.001). After adjusting for presenting triage category, admission lactate and presenting qSOFA scores, this association remained significant (adjusted odds ratio 9.99; 95% confidence interval 4.7-21.3). Significant improvements were observed for proportion of patients who had intravenous fluids initiated within 60 min (47.5% vs 72.1%); proportion of patients who had serum lactate measured within 60 min (50.0% vs 77.9%) and proportion of patients who had blood cultures performed within 60 min (52.5% vs 85.6%). Implementation of a sepsis alert response that included early involvement of the EM pharmacist was associated with improvement in time to antimicrobials and other components of the sepsis bundle. An upfront, multidisciplinary approach to patients presenting to the ED with suspected sepsis should be considered more broadly.
Identifiants
pubmed: 36634917
doi: 10.1111/1742-6723.14168
doi:
Substances chimiques
Lactic Acid
33X04XA5AT
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
564-571Informations de copyright
© 2023 Australasian College for Emergency Medicine.
Références
Evans L, Rhodes A, Alhazzani W et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit. Care Med. 2021; 49: e1063-143.
Rudd KE, Johnson SC, Agesa KM et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. Lancet 2020; 395: 200-11.
Peltan ID, Brown SM, Bledsoe JR et al. ED door-to-antibiotic time and long-term mortality in sepsis. Chest 2019; 155: 938-46.
Seymour CW, Gesten F, Prescott HC et al. Time to treatment and mortality during mandated emergency care for sepsis. N. Engl. J. Med. 2017; 376: 2235-44.
Liu VX, Fielding-Singh V, Greene JD et al. The timing of early antibiotics and hospital mortality in sepsis. Am. J. Respir. Crit. Care Med. 2017; 196: 856-63.
Kumar A, Roberts D, Wood KE et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit. Care Med. 2006; 34: 1589-96.
ARISE Investigators, ANZICS Clinical Trials Group, Peake SL et al. Goal-directed resuscitation for patients with early septic shock. N. Engl. J. Med. 2014; 371: 1496-506.
ProCESS Investigators, Yealy DM, Kellum JA et al. A randomized trial of protocol-based care for early septic shock. N. Engl. J. Med. 2014; 370: 1683-93.
Mouncey PR, Osborn TM, Power GS et al. Trial of early, goal-directed resuscitation for septic shock. N. Engl. J. Med. 2015; 372: 1301-11.
Filbin MR, Thorsen JE, Zachary TM et al. Antibiotic delays and feasibility of a 1-hour-from-triage antibiotic requirement: analysis of an emergency department sepsis quality improvement database. Ann. Emerg. Med. 2020; 75: 93-9.
Nevill A, Kuhn L, Thompson J, Morphet J. The influence of nurse allocated triage category on the care of patients with sepsis in the emergency department: a retrospective review. Australas. Emerg. Care 2021; 24: 121-6.
Roman CP, Poole SG, Dooley MJ, Smit DV, Mitra B. Implementation of hospital-wide reform at improving access and flow: impact on time to antibiotics in the emergency department. Emerg. Med. Australas. 2016; 28: 133-7.
Yealy DM, Mohr NM, Shapiro NI, Venkatesh A, Jones AE, Self WH. Early care of adults with suspected sepsis in the emergency department and out-of-hospital environment: a consensus-based task force report. Ann. Emerg. Med. 2021; 78: 1-19.
Roman C, Edwards G, Dooley M, Mitra B. Roles of the emergency medicine pharmacist: a systematic review. Am. J. Health Syst. Pharm. 2018; 75: 796-806.
Robey-Gavin E, Abuakar L. Impact of clinical pharmacists on initiation of postintubation analgesia in the emergency department. J. Emerg. Med. 2016; 50: 308-14.
Acquisto NM, Hays DP, Fairbanks RJ et al. The outcomes of emergency pharmacist participation during acute myocardial infarction. J. Emerg. Med. 2012; 42: 371-8.
Roman C, Cloud G, Dooley M, Mitra B. Involvement of emergency medicine pharmacists in stroke thrombolysis: a cohort study. J. Clin. Pharm. Ther. 2021; 46: 1095-102.
Thomas MC, Acquisto NM, Shirk MB, Patanwala AE. A national survey of emergency pharmacy practice in the United States. Am. J. Health Syst. Pharm. 2016; 73: 386-94.
Welch S, Currey E, Doran E et al. Standard of practice in emergency medicine for pharmacy services. J. Pharm. Pract. Res. 2019; 49: 570-84.
Ernst AA, Weiss SJ, Sullivan A et al. On-site pharmacists in the ED improve medical errors. Am. J. Emerg. Med. 2012; 30: 717-25.
Australian Comission on Safety and Quality in Health Care. National Sepsis Program. 2021. [Cited 6 Jan 2023.] Available from URL: https://www.safetyandquality.gov.au/our-work/partnering-consumers/national-sepsis-program
Tong E, Roman C, Mitra B et al. Partnered pharmacist charting on admission in the general medical and emergency short-stay unit - a cluster-randomised controlled trial in patients with complex medication regimens. J. Clin. Pharm. Ther. 2016; 41: 414-8.
Cairns KA, O'Brien DJW, Corallo CE, Guidone DM, Dooley MJ. Pharmacist-led therapeutic drug monitoring: implementation of a successful credentialing model. J. Pharm. Pract. Res. 2017; 47: 477-82.
Singer M, Deutschman CS, Seymour CW et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016; 315: 801-10.
Australian Commission on Safety and Quality in Health Care. Sepsis Clinical Care Standard. 2022. [Cited 6 Jan 2023.] Available from URL: https://www.safetyandquality.gov.au/standards/clinical-care-standards/sepsis-clinical-care-standard
Burrell AR, McLaws M-L, Fullick M, Sullivan RB, Sindhusake D. SEPSIS KILLS: early intervention saves lives. Med. J. Aust. 2016; 204: 73.
Weant KA, Baker SN. Emergency medicine pharmacists and sepsis management. J. Pharm. Pract. 2013; 26: 401-5.
Moussavi K, Nikitenko V. Pharmacist impact on time to antibiotic administration in patients with sepsis in an ED. Am. J. Emerg. Med. 2016; 34: 2117-21.
Yarbrough N, Bloxam M, Priano J, Louzon Lynch P, Hunt LN, Elfman J. Pharmacist impact on sepsis bundle compliance through participation on an emergency department sepsis alert team. Am. J. Emerg. Med. 2019; 37: 762-3.
Beardsley JR, Jones CM, Williamson J, Chou J, Currie-Coyoy M, Jackson T. Pharmacist involvement in a multidisciplinary initiative to reduce sepsis-related mortality. Am. J. Health Syst. Pharm. 2016; 73: 143-9.
Welch S. Antimicrobial stewardship in Australian emergency departments. Emerg. Med. Australas. 2015; 27: 427-30.
Li L, Walter SR, Rathnayake K, Westbrook JI. Evaluation and Optimisation of Risk Identification Tools for the Early Detection of Sepsis in Adult Inpatients. Report to the Clinical Excellence Commission (CEC). Sydney: Australian Institute of Health Innovation, Macquarie University, 2018.
Gatewood MO, Keefe WM, Greco S, Kritek PA, Durvasula R. A quality improvement project to improve early sepsis care in the emergency department. BMJ Qual. Saf. 2015; 24: 787-95.
Hwang MI, Bond WF, Powell ES. Sepsis alerts in emergency departments: a systematic review of accuracy and quality measure impact. West. J. Emerg. Med. 2020; 21: 1201-10.