Monthly Publication Highlights Pharmacists’ Vital Role in the Time-Critical Treatment of Sepsis
Aug 01, 2014
The UK College of Pharmacy Research Publication Highlight for July 2014 showcases how the placement of a pharmacist on a multidisciplinary health care team can play a vitally important role in the resuscitation of patients with sepsis.
The article was published in Annals of Pharmacotherapy and is entitled, “Utilization of Pharmacist Responders as a Component of a Multidisciplinary Sepsis Bundle.”
This collaborative, retrospective, case-control study was conducted by Drs. Jeremy Flynn, Clinical Pharmacy Specialist, Alexander Flannery, Critical Care Pharmacist, and Melissa Nestor, Clinical Staff Pharmacist, from UK HealthCare Pharmacy Services. Dr. Kevin McConeghy, a former UK Pharmacy Resident who is now an Infectious Disease Fellow at the University of Illinois-Chicago, Pam Branson, Clinical Nurse Specialist in Neurosciences, and Dr. Kevin Hatton, Division Chief for Critical Care in the Department of Anesthesiology, contributed significantly to the project and are co-authors on the publication.
Severe sepsis or septic shock is a life-threatening, dysregulated physiologic and exaggerated inflammatory response to infection that carries a high risk of death, with 215,000 deaths each year in the United States. Of the few strategies known to reduce the risk of death, the prompt administration of appropriate (pathogen susceptible) antibiotics is regarded as one of the most vital steps to care for these patients. Mortality increases by 7.6 percent for every hour delay in antibiotic administration. However, across the country, time to appropriate antibiotic administration remains problematic. The complexity of these patients, as well as logistical delays in obtaining medication from the pharmacy department and administering the medication, often results in time to antibiotic administration of greater than one hour.
To that end, UK HealthCare developed a process in which a pharmacist is on-call 24 hours a day, 365 days per year. Pharmacy residents respond to the “sepsis bundle” by attending at the patient’s beside, discussing the case with the medical team, recommending appropriate antimicrobials based on the patient’s history and information in the chart, as well as facilitating the preparation and administration of the antibiotics. Comparing the time to antibiotic administration before and after implementation of this process yielded astonishing results. Using pharmacists as part of the multidisciplinary sepsis bundle, the odds of receiving antibiotics within one hour were about 20 times greater than before implementation of this new protocol. Time (~30 minutes) to appropriate antibiotic administration in this study using the pharmacist responders is the shortest time to antibiotic administration reported in the literature.
“This study provides evidence of the leadership role that University of Kentucky pharmacists play in offering a roadmap for other institutions to follow to allow pharmacists to intervene, optimize time to antibiotic administration, and potentially improve outcomes of patients with sepsis,” said Linda Dwoskin, Associate Dean for Research.