Electronic prescribing: Introducing a stat optional dose to improve time to antibiotic on the acute medical unit

Abstract

Darlington Memorial Hospital is a district general hospital in the North East of England. The acute medical unit (AMU) takes referrals from the emergency department and also direct from general practitioners (GPs) in the region. Research shows that early recognition and management of sepsis is key to improving outcomes and significantly decreases mortality. Having observed several cases of delayed sepsis management in patients referred from their GP, we aimed to improve time to antibiotic therapy in patients identified as having sepsis as per the National Institute for Health and Care Excellence 2016 NG51 sepsis guidelines. We analysed the time from admission to antibiotic administrations for patients referred to AMU via their GP with suspected sepsis. We found there was a significant delay between antibiotic prescribing and administration. Baseline data showed that only 36% of patients received a stat dose of antibiotic on admission. Results showed that those patients with a stat dose prescribed had a median time of 36 min from prescription to antibiotic compared with 98 min for those without. We introduced a stat antibiotic option with all antibiotic prescriptions on the electronic prescribing system, encouraging prescribers to administer a stat dose. Through focusing on antibiotic prescribing systems and practices over two PDSA cycles, we were able to improve the time from prescription to administration of antibiotics for patients with sepsis. We reduced the delay in antibiotic administration in patients with sepsis from 49 to 34 min, an improvement of 31% (15/49). The percentage of patients receiving a stat dose of antibiotics increased from 36% to 63%. While we acknowledge that there remains room for improvement with regards to antibiotic prescribing and sepsis management, we have made sustainable interventions with important improvements. E-prescribing systems must be evaluated and modified accordingly on a regular basis to ensure that they positively contribute to quality patient care and clinical practice.