title: Impact of a Multidisciplinary Bundle on Time to Antibiotic Administration in Septic SICU Patients.
abstract: OBJECTIVE
  The goal of this study was to investigate barriers to timely antibiotic administration in septic surgical intensive care unit (SICU) patients and examine the impact of a multidisciplinary bundle on the time from prescription to antibiotic administration.
  
  
  METHODS
  This was a pre- and postintervention study that consisted of 3 phases: (1) preintervention phase, retrospective evaluation of data, (2) intervention implementation, and (3) a postintervention phase. A nurse survey was conducted to identify barriers to rapid antibiotic administration during phase 1. Based on this survey, multidisciplinary interventions included adding antibiotics to the automatic dispensing cabinet, educating monthly staff, and providing an antibiotic dosing table to all prescribers, which is attached to the computer workstations. Our multidisciplinary team consisted of the ICU medical directors, nurse managers, nurses, a critical care fellow, and ICU pharmacists.
  
  
  RESULTS
  The percentage of antibiotics that were received within 60 minutes was 26.3% in the pregroup versus 84.0% in the postgroup ( P < .001). The mean total prescriber to patient time was 110 minutes in the pregroup versus 58.4 minutes in the postgroup ( P < .001).
  
  
  CONCLUSIONS
  We achieved a higher rate of timely antibiotic administration among septic SICU patients by implementing process changes based on barriers identified by the nurses.
authors.affiliation: 1 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ohoud
authors.initials: O
authors.lastname: Almalki
authors.affiliation: 2 Department of Pharmacy Practice and Administration, University of Saint Joseph School of Pharmacy, Hartford, CT, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Levine
authors.affiliation: 3 Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Turner
authors.affiliation: 1 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Newman
authors.affiliation: 3 Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: DeMoya
authors.affiliation: 4 Department of Surgery and Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
authors.affiliation: 5 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
authors.affiliation: 1 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Hsin
authors.initials: H
authors.lastname: Lin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003422:Critical Care / Q000592:standards*; D054796:Drug Dosage Calculations; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents
keywords: multidisciplinary critical care; quality; sepsis