Background, Rationale, and Suggested Implementation Strategies
- Involve Antimicrobial Stewardship teams and/or Infectious Disease physicians, pharmacists, and nurses in Sepsis committees/workgroups at your local institution.
- Identify local/unit lead for sepsis-related antimicrobial stewardship improvement efforts. This person would be responsible for ensuring implementation of interventions recommended by the sepsis committee/workgroup, as well as identifying and troubleshooting barriers noted during implementation.
- Meet quarterly to review data, define problem areas, identify underlying causes, and determine interventions for improvement related to antimicrobial stewardship in sepsis.
- Communicate antimicrobial stewardship work to local leadership to ensure institutional buy-in.
- When implementing antibiotic stewardship interventions consider using behavioral economics techniques: in other words, make the right thing easier(e.g., automatic) and the wrong thing harder(e.g., removing from order sets).
- Assess post-intervention data for impacts of the intervention, modify intervention as needed.
- Encourage documentation of dose, indication, and duration of antibiotics in daily progress notes
- Utilize antibiotic time outs, including:
- Assess indication(s) for antibiotics
- Review culture results
- De-escalate or discontinue antibiotics based on culture results, clinical stability
- If ongoing antibiotics, consider switching to oral route of administration
- If ongoing antibiotics, decide and document treatment duration
- Engage infectious disease consultation teams early in sepsis management.
- Engage pharmacists to review culture data and tailor antibiotic plan to individual patient
- Ensure all days of antibiotic therapy(including intravenous therapy) are included when determining ongoing duration of antibiotic therapy
Recommendations from CDC Core Elements of Antimicrobial Stewardship on Sepsis Interventions
- Develop antibiotic recommendations for sepsis that are based on local microbiology data
- Ensuring protocols are in place to administer antibiotics quickly in cases of suspected sepsis
- Ensure there are mechanisms in place to review antibiotics started for suspected sepsis so that therapy can be tailored or stopped if deemed unnecessary