Time from recognition of sepsis to treatment - A 2-month retrospective study of compliance of IV antibiotics at Queen's Hospital Burton

Abstract

Introduction

Sepsis is the presence (probable or documented) of infection. With its systemic manifestations of severe sepsis and septic shock posing a major healthcare burden in the UK and globally, there is clearly a potential for physician and patient awareness. Current evidence suggests that administration of appropriate antibiotic therapy within 1 hour on recognition of sepsis and its sequelae improves mortality rates among patients. In the UK, the National Institute of Clinical Excellence (NICE) and The Surviving Sepsis Campaign (SSC) recommends the use of intravenous antibiotics within the first hour of recognition of sepsis.

Case description

To determine the number of patients receiving their antibiotics within 1 hour from recognition of sepsis and to assess compliance of Queen’s Hospital Burton Trust (QHBT) with the NICE and Surviving Sepsis Campaign’s recommendation for early antibiotic therapy. A 2-month retrospective chart analysis was conducted to determine the interval from documented onset of sepsis to initial administration of antibiotic for patients at QHBT. Inclusion criteria included patients presenting to Accident and Emergency aged 16 and over scoring 4 or more on their NEWS (National Early Warning Chart Scoring) chart. Patients presenting to a paediatric and gynaecological/obstetric setting were excluded. Patients started on antibiotics at the GP were also excluded.

Results and Conclusions

Charts of 82 patients with documented sepsis were reviewed. 51 patients received their antibiotics within 1 hour representing 62% of all patients presenting to Accident and Emergency at QHBT over the 2 months period. At QHBT, over the 2-month period, very few patients receiving their antibiotics within 1 hour. Therefore, the administration of antibiotics in 38% of all patients exceeded the 1 hour period recommended by NICE and Surviving Sepsis Campaign guidelines. These results have been used as a baseline for future quality assurance and improvement initiatives aimed at minimizing the time to antibiotic administration for this group of patients, who are at high risk of death. Data have been shared with physicians, allied health professionals and patient groups at board meetings. A re-audit is in process with initial results looking promising.