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Published on: August 30, 2018
Reduction in Antibiotic Delivery Time Following Improving Pediatric Sepsis Outcomes Quality Improvement Initiative at
Meghan Gill1, Vikram Raghu2, Elizabeth Ferguson1
1Department of Pharmacy (EF, KC, MG), UPMC Children's Hospital of Pittsburgh.
Insights
Pharmacy interventions significantly reduced antibiotic delivery times for pediatric sepsis patients, improving sepsis outcomes. Streamlined processes and prioritized orders achieved faster delivery, crucial for timely treatment.
Area of Science:
- Pediatric critical care
- Hospital pharmacy operations
- Sepsis management
Background:
- Sepsis poses significant risks to pediatric patients, with timely antibiotic administration being critical for improved outcomes.
- The hospital pharmacy plays a vital role in the efficiency of antibiotic delivery, directly impacting patient care timelines.
Purpose of the Study:
- To evaluate and optimize the pharmacy process for antibiotic orders in pediatric sepsis cases.
- To decrease the median time from antibiotic order placement to delivery to under 45 minutes.
Main Methods:
- Utilized Lean Six Sigma methodology, including process mapping, to identify bottlenecks in antibiotic delivery.
- Implemented interventions such as educational programs for providers and optimized order prioritization.
- Analyzed antibiotic order data from April to December 2019, focusing on delivery and administration times.
Main Results:
- Stat orders were delivered significantly faster (40.5 minutes) than routine orders (51 minutes).
- Orders utilizing the PowerPlan (20.5 minutes) showed markedly quicker delivery compared to non-PowerPlan orders (47 minutes).
- Pneumatic tube delivery resulted in shorter administration times (41 minutes) compared to other delivery methods.
Conclusions:
- Multifactorial, coordinated interventions within the pharmacy department effectively reduced medication delivery times for pediatric sepsis antibiotic orders.
- Optimizing pharmacy workflows is essential for improving the timeliness of critical antibiotic administration in pediatric sepsis.
Objective:
Sepsis causes morbidity and mortality in pediatric patients, but timely antibiotic administration can improve sepsis outcomes. The pharmacy department can affect the time from order to delivery of antibiotics. By evaluating the pharmacy process, this study aimed to decrease the time from antibiotic order to delivery to within 45 minutes.
Methods:
All antibiotic orders placed following a positive sepsis screen for acute care patients at a freestanding children's hospital from April 1, 2019, to December 31, 2019, were reviewed. Lean Six Sigma methodology including process mapping was used to identify and implement improvements, including educational interventions for providers. Outcome measures included time from antibiotic order placement to delivery and to administration. Additional assessment of process measures included evaluation of order priority, PowerPlan (an internally created order set) use, and delivery method.
Results:
Ninety-eight antibiotic orders for 85 patients were evaluated. In an individual chart of antibiotic delivery time, a trend towards faster delivery time was observed after interventions. Stat orders (40.5 minutes [IQR, 19.5-48]) were delivered more quickly than routine orders (51 minutes [IQR, 45-65]; p < 0.001). Orders using the PowerPlan (20.5 minutes [IQR, 18.5-38]) were delivered more quickly than those that did not (47 minutes [IQR, 34-64]; p < 0.01). Shorter time to administration was observed with pneumatic tube delivery (41 minutes [IQR, 20-50]) than with direct delivery to a health care provider (51 minutes [IQR, 31-83]; p < 0.05) or to the automated dispensing cabinet's refrigerator (47 minutes [IQR, 41-62]; p < 0.0001).
Conclusions:
Multifactorial coordinated interventions within the pharmacy department improve medication delivery time for pediatric sepsis antibiotic orders.
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