Reduction in Antibiotic Delivery Time Following Improving Pediatric Sepsis Outcomes Quality Improvement Initiative at a Major Children's Hospital

Abstract

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.