The following is a summary of “Association between emergency department sepsis order set design and delay to second dose piperacillin-tazobactam administration,” published in the May 2023 issue of Emergency Medicine by Erickson, et al.

Studies have found that delayed administration of antibiotics in patients with sepsis is associated with increased mortality. While the negative impact of delayed administration of the first dose of antibiotics is well-established, it is also suggested that delayed administration of the second dose can worsen patient outcomes. However, there was a lack of clear guidelines on reducing the delay in administering the second dose of antibiotics. Therefore, for a study, researchers sought to assess whether changing an emergency department (ED) sepsis order set from one-time doses to scheduled antibiotic frequencies reduces the delay in administering the second dose of piperacillin-tazobactam.

The retrospective cohort study was carried out at eleven hospitals within a sizable integrated healthcare system. During two years, they included adult patients who received at least two doses of piperacillin-tazobactam prescribed through an ED sepsis order set. The scheduled antibiotic frequencies were added to the ED sepsis order set in the middle of the research period. The study analyzed two patient cohorts: one from the year before the update and one from the year following the update. The main result was a “major delay,” indicated by the second piperacillin-tazobactam being administered >25% after the suggested dosing interval. This result was assessed using interrupted time series analysis and multivariable logistic regression.

The study included 3,219 patients: 1,222 in the pre-update group and 1,997 in the post-update group. The proportion of patients who experienced a major delay in receiving the second dose was significantly lower in the post-update group (32.7% vs. 25.6%, P < 0.01; adjusted odds ratio 0.64, 95% CI 0.52 to 0.78). Although there was no difference in the slope of monthly major delay frequency between the two groups, there was a significant level change, with a post-update change of -10% (95% CI -17.9% to -1.9%).

The study findings suggested that updating the ED sepsis order set to include scheduled antibiotic frequencies effectively decreases delays in administering the second dose of antibiotics. The pragmatic approach can potentially improve patient outcomes by reducing the risk of major delays in the administration of antibiotics in patients with sepsis.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000670