The following is a summary of “Order Set Design and Delay to Second Dose Piperacillin-Tazobactam in ED Sepsis,” published in the May 2023 issue of Emergency Medicine by Erickson et al.

Delay in administering the first dose of antibiotics to sepsis patients has been linked to increased mortality. Delay in administering the second dose of an antibiotic has also been linked to poorer patient outcomes. Optimal strategies for reducing second dose delay are currently unknown. This study’s primary objective was to evaluate the association between updating an emergency department (ED) sepsis order set design from one-time doses to scheduled antibiotic frequencies and the delay in administering the second piperacillin-tazobactam dose. 

This two-year retrospective cohort study was conducted at eleven institutions within a large, integrated health system and included adult patients treated in the ED with at least one dose of piperacillin-tazobactam prescribed via an ED sepsis order set. Patients who received fewer than two doses of piperacillin-tazobactam were excluded. The enterprise-wide ED sepsis order set was updated midway through the study period to include scheduled antibiotic frequencies. Two patient cohorts receiving piperacillin-tazobactam were compared: those in the year preceding the update to the order set and those following the update. Major delay, an administration delay >25% of the recommended medication interval, was evaluated using multivariable logistic regression and interrupted time series analysis.

Included were 3,219 patients: 1,222 in the pre-update cohort and 1,997 in the update group. Significantly fewer patients in the post-update group experienced significant second dose delays (32.7% vs. 25.6%, P<0.01; adjusted OR 0.64, 95% CI 0.52 to 0.82). The monthly main delay frequency slope did not differ between groups, but there was a significant level change (post-update change -10%, 95% CI -17.9% to -1.9%). Incorporating antibiotic frequency into the emergency department (ED) sepsis order sets is a pragmatic way to reduce delays in second antibiotic doses.

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