Pharmacist involvement in sepsis response and time to antibiotics: A systematic review

Abstract

Introduction Sepsis is a life‐threatening medical emergency and a leading cause of morbidity and mortality worldwide. Reductions in time to antibiotics in patients presenting with sepsis or septic shock are associated with reduced mortality, and Surviving Sepsis Campaign guidelines recommend antibiotics within 1 h of recognition. Pharmacists are well‐equipped to help navigate the therapeutic and operational challenges associated with achieving this goal. Objectives To assess the association of pharmacist involvement in sepsis response with time to antibiotics in hospitalized patients with sepsis and septic shock. Methods A systematic review of the following databases was conducted: PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Studies must have included a designated role of an individual pharmacist in the management of sepsis or septic shock and not be considered an operational change. The primary outcome of interest was time to antibiotic administration, with secondary outcomes including intensive care unit (ICU) and hospital length of stay as well as in‐hospital mortality. Results We identified 10 studies including 1772 patients with sepsis or septic shock that evaluated a sepsis response in which a pharmacist was included. Studies included patients in the ICU, emergency department, and hospital ward setting. Seven studies demonstrated a significant reduction in time to antibiotics, with two other studies supporting this conclusion in extrapolation or sensitivity analysis. There was not a consistent reduction in ICU or hospital length of stay nor in‐hospital mortality between those interventions involving a pharmacist compared with their defined control groups. Conclusion Pharmacist involvement in sepsis response, often as part of a multiprofessional team‐based approach to sepsis care, is associated with a reduced time to antibiotic administration for hospitalized patients with sepsis or septic shock.

Survey‐based evaluation of national practices for postgraduate year one pharmacy resident emergency response training

“…A more novel type of emergency response, based on the results of this survey, includes response to sepsis events. Literature supports the role of the pharmacist in this area, including reduced time to antimicrobial administration 18 . The integration of pharmacy residents in these experiences may enhance their skills including rapid decision making and knowledge of medication therapy.…”

“…Literature supports the role of the pharmacist in this area, including reduced time to antimicrobial administration. 18 The integration of pharmacy residents in these experiences may enhance their skills including rapid decision making and knowledge of medication therapy. Additionally, emergency response may be a requirement for future jobs, given the increasing participation of pharmacists in emergency response and the recommendation that they participate in and have key roles in emergency response, as recommended by an ASHP report.…”

Continuing excellence in critical care pharmacy practice, education, and advocacy

“…Critical care pharmacist participation on the multidisciplinary team has also demonstrated considerable benefits in areas such as anticoagulation, 9,10 antimicrobial therapy, 11 pain, agitation and sleep management, 12–14 and overall medication safety 15 . The ICU Liberation Campaign represents bundled interventions conducted by an interdisciplinary team, including a critical care pharmacist that has been associated with improvement in survival, ICU length of stay, and ICU readmission 16 .…”

“…Interpreting complicated pharmacokinetics/pharmacodynamics using advanced therapeutic drug monitoring, 5 evaluation of patient clinical status and organ function, 6 or the ordering and utilization of procedures or laboratory assays to provide optimal pharmacotherapy are now common practice for most critical care pharmacists. 7,8 Critical care pharmacist participation on the multidisciplinary team has also demonstrated considerable benefits in areas such as anticoagulation, 9,10 antimicrobial therapy, 11 pain, agitation and sleep management, [12][13][14] and overall medication safety. 15 The ICU Liberation Campaign represents bundled interventions conducted by an interdisciplinary team, including a critical care pharmacist that has been associated with improvement in survival, ICU length of stay, and ICU readmission.…”