title: Pharmacist involvement in a multidisciplinary initiative to reduce sepsis-related mortality.
abstract: OBJECTIVE
  Pharmacy department contributions to a medical center's broad initiative to improve sepsis care outcomes are described.
  
  
  CONCLUSIONS
  Timely and appropriate antimicrobial therapy is a key factor in optimizing treatment outcomes in patients with severe sepsis or septic shock. The inpatient pharmacy at Wake Forest Baptist Health implemented standardized processes to reduce order turnaround time and facilitate prompt antibiotic administration as part of the hospital's multidisciplinary "Code Sepsis" initiative. The program includes (1) nurse-conducted screening for sepsis using a standard assessment instrument, (2) pager alerts notifying rapid-response, pharmacy, and other personnel of cases of suspected sepsis, (3) activation of an electronic order set including guideline-based antibiotic therapy recommendations based on local pathogen patterns, and (4) a protocol allowing pharmacists to select an antibiotic regimen if providers are busy with other patient care duties. Assessments conducted during and after implementation of the Code Sepsis initiative showed improvements in key program metrics. The mean ± S.D. time from receipt of a Code Sepsis page to antibiotic delivery was reduced to 14.1 ± 13.7 minutes, the mean time from identification of suspected sepsis to antibiotic administration was reduced to 31 minutes in the hospital's intensive care units and to 51 minutes in non-critical care units, and the institution's performance on a widely used measure of sepsis-related mortality improved dramatically.
  
  
  CONCLUSIONS
  Implementation of the Code Sepsis initiative was associated with reductions in order turnaround time, time to antibiotic administration, and sepsis-related mortality.
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, NC. jbeardsl@wakehealth.edu.
authors.forename: James R
authors.initials: JR
authors.lastname: Beardsley
authors.affiliation: University of Missouri Health Sciences Center, Columbia, MO.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Jones
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: John
authors.initials: J
authors.lastname: Williamson
authors.affiliation: Ochsner Medical Center, New Orleans, LA.
authors.forename: Jason
authors.initials: J
authors.lastname: Chou
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Margaret
authors.initials: M
authors.lastname: Currie-Coyoy
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, NC.
authors.forename: Teresa
authors.initials: T
authors.lastname: Jackson
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002985:Clinical Protocols; D006801:Humans; D009657:North Carolina; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010607:Pharmacy Service, Hospital / Q000592:standards*; D018805:Sepsis / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents