Vanessa Ulloa, BCCCP, PharmD,
Cleveland Clinic Florida
Weston, Florida
Disclosure information not submitted.
Gabriela Iturralde, PharmD
Clinical Pharmacist
Cleveland Clinic Weston, United States
Disclosure information not submitted.
Title: Impact of an emergency medicine pharmacist on time to antibiotic administration in sepsis patients
Introduction: The American Society of Health-System Pharmacists (ASHP) published Guidelines on Emergency Medicine Pharmacist Services to produce a consistent approach and ideal practice model for emergency medicine pharmacist (EMP). The purpose of the study was to assess if the presence of an emergency medicine pharmacist in the emergency department is associated with a decreased time to antibiotic administration in patients with sepsis.
Methods: A single-center retrospective cohort study was performed from August 2019 to January 2021. All adult patients who presented to the emergency department with severe sepsis or septic shock were reviewed. The inclusion criteria included patients who met sepsis criteria in the ED. Patients were excluded from the study if they tested positive for COVID-19 at the time of presentation, initial work-up excluded severe sepsis and septic shock, and those that presented outside of the emergency medicine clinical pharmacist's hours. The control group included patients presenting to the ED without an EMP present and the study group included patients presenting to the ED with an EMP present. The primary outcome was the median time from sepsis identification to antibiotic administration. Secondary outcomes included antibiotics administered within one hour, in-hospital mortality and length of stay.
Results: The study included 200 patients, 100 in the study group and 100 in the control group. Although not statistically significant, time to antibiotic administration decreased from 113 minutes (IQR 70-166) in the control group to 105 minutes in the study group (IQR 66-134, p=0.34). More patients in the study group received antibiotics within one hour (p=0.78). The in-hospital mortality was 2% in the study group and 3% in the control group (p=0.69). Lastly, the hospital length of stay was approximately 4 days (2-7.75) in the study group and 3 days in the control group.
Conclusions: This study revealed a trend towards a decrease in median time from sepsis identification to antibiotic administration with an EMP present, however not statistically significant. An improvement in the percentage of patients receiving antibiotics within an hour of sepsis identification was also revealed. Although the study did not detect statistical significance it was underpowered and warrants further research.