South African pharmacists impact on antibiotic hang-time in the intensive care unit patients

Background: The International Guidelines for Management of Severe Sepsis and Septic Shock recommend the administration of effective intravenous antimicrobials within the first hour of recognition of septic shock.With every hour of delay in the administration of appropriate antimicrobial therapy, mortality increases by 7.6%. The time from the written antibiotic order to actual intravenous administration or “hang-time” can often be several hours due to logistics within the hospital. Netcare (Ltd), a 54 private sector hospital system across South Africa implemented the practice of administering antimicrobials within an hour following prescription through a national antibiotic stewardship pharmacist-driven “hang-time” process improvement protocol. Methods & Materials: This pre-post intervention study was implemented by pharmacists in the Intensive Care Units (ICU) of thirty-nine hospitals in collaboration with nursing and infection prevention practitioners. A four-week baseline study was conducted to determine “hang-time” compliance within one hour. A data collection template was developed and a weekly measure of compliance to “hang-time”withinonehourwasdocumented retrospectively. Following this, a “hang-time” poster was used to create awareness in the units and rigorous training sessions were conductedby thewardpharmacists to nursing staff, including all shifts, regarding the importance of the early administration of antimicrobials to decrease patientmortality and enhance best patient care. In addition, ward pharmacists added the most commonly prescribed antibiotics to the ward stock to help decrease nursing delays in the administration timeof antibiotics.Wardpharmacists prospectively collectedup to23weeksof “hang-time” compliancedatapost intervention. Statistical analysiswas done using a 2-tailed Fisher’s Exact test. Results: In total 7,750 (pre=1,976andpost=5,774)patient charts were reviewed for “hang-time” compliance. A significant improvement in “hang-time” compliance within one hour was observed between the pre-intervention week one (41%) and post intervention week 23 (82%) p<0.001. Conclusion: A stewardship process improvement protocol with ward pharmacist’s interventions significantly improved the hang-time of antibiotics in ICU patients with sepsis. Stewardship programs with limited resources should consider implementing hang-time protocols. Future studies will measure the impact of “hang-time” compliance on patient mortality.