title: A survey of critical care nurses' practices and perceptions surrounding early intravenous antibiotic initiation during septic shock.
abstract: BACKGROUND
  Delays in antibiotic administration after severe sepsis recognition increases mortality. While physician and pharmacy-related barriers to early antibiotic initiation have been well evaluated, those factors that affect the speed by which critical care nurses working in either the emergency department or the intensive care unit setting initiate antibiotic therapy remains poorly characterized.
  
  
  OBJECTIVE
  To evaluate the knowledge, practices and perceptions of critical care nurses regarding antibiotic initiation in patients with newly recognised septic shock.
  
  
  METHODS
  A validated survey was distributed to 122 critical care nurses at one 320-bed academic institution with a sepsis protocol advocating intravenous(IV) antibiotic initiation within 1hour of shock recognition.
  
  
  RESULTS
  Among 100 (82%) critical care nurses responding, nearly all (98%) knew of the existence of the sepsis protocol. However, many critical care nurses stated they would optimise blood pressure [with either fluid (38%) or both fluid and a vasopressor (23%)] before antibiotic initiation. Communicated barriers to rapid antibiotic initiation included: excessive patient workload (74%), lack of awareness IV antibiotic(s) ordered (57%) or delivered (69%), need for administration of multiple non-antibiotic IV medications (54%) and no IV access (51%).
  
  
  CONCLUSIONS
  Multiple nurse-related factors influence IV antibiotic(s) initiation speed and should be incorporated into sepsis quality improvement efforts.
authors.affiliation: Department of Pharmacy, Tufts Medical Center, 800 Washington Street, Box 420, Boston, MA 02111, USA; School of Pharmacy, Northeastern University, 360 Huntington Ave, R218 TF, Boston, MA 02115, USA. Electronic address: russelrx@gmail.com.
authors.forename: Russel J
authors.initials: RJ
authors.lastname: Roberts
authors.affiliation: Department of Pharmacy, King Khalid University Hospital, P.O. Box 2457, Riyadh 11451, Saudi Arabia. Electronic address: aalhammad@ksu.edu.sa.
authors.forename: Abdullah M
authors.initials: AM
authors.lastname: Alhammad
authors.affiliation: Department of Nursing, Tufts Medical Center, Boston, MA, USA. Electronic address: lcrossley@tuftsmedicalcenter.org.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Crossley
authors.affiliation: Department of Nursing, Tufts Medical Center, Boston, MA, USA. Electronic address: eanketell@tuftsmedicalcenter.org.
authors.forename: Eric
authors.initials: E
authors.lastname: Anketell
authors.affiliation: Department of Nursing, Tufts Medical Center, Boston, MA, USA. Electronic address: lwood@tuftsmedicalcenter.org.
authors.forename: LeeAnn
authors.initials: L
authors.lastname: Wood
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, USA. Electronic address: gschumaker@tuftsmedicalcenter.org.
authors.forename: Greg
authors.initials: G
authors.lastname: Schumaker
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, USA. Electronic address: egarpestad@tuftsmedicalcenter.org.
authors.forename: Erik
authors.initials: E
authors.lastname: Garpestad
authors.affiliation: School of Pharmacy, Northeastern University, 360 Huntington Ave, R218 TF, Boston, MA 02115, USA; Division of Pulmonary, Critical Care and Sleep Medicine, USA. Electronic address: j.devlin@neu.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D064648:Critical Care Nursing / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D010465:Perception; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality / Q000451:nursing; D011795:Surveys and Questionnaires; D013997:Time Factors; D000078329:Workforce
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic; Barriers; Intensive care; Nurse; Nursing; Quality improvement; Sepsis; Septic shock