482: IMPACT OF COMPUTERIZED PROVIDER ORDER ENTRY (CPOE) IMPLEMENTATION ON THE TIMING OF ANTIBIOTIC ADMINISTRATION IN INPATIENTS WITH SEVERE SEPSIS AND SEPTIC SHOCK

Abstract

To assess if computerized provider order entry (CPOE) improves adherence to the Surviving Sepsis Campaign (SSC) standard of timely antibiotic administration in inpatients with severe sepsis or septic shock at a tertiary academic medical center.

Implementation of CPOE decreases the time to antibiotic administration in inpatients with severe sepsis and septic shock.

Retrospective and concurrent review of inpatients with severe sepsis or septic shock was conducted comparing time from antibiotic order to administration prior to (2009-2010) and after (2012) CPOE implementation. Major exclusion criteria were age < 18 years, admission with severe sepsis or septic shock from the emergency department or an outside facility, or sepsis due to fungal or viral pathogens. Medical record review was used to determine the time of presentation (TOP) of severe sepsis and septic shock (defined as systolic blood pressure < 90 mmHg or lactate? 4 mmol/L) and times of: antibiotic order, pharmacy verification, and administration to identify barriers leading to treatment delay. Data were analyzed using the Student’s t-test.

Fifty-nine inpatients (n=47 pre-CPOE, n=12 post-CPOE) with severe sepsis or septic shock met study criteria. Mean time from antibiotic order to administration was significantly reduced post-CPOE (52.1 ± 29.3 vs.106 ± 63.9 minutes, p=0.006). Twenty-five percent of the post-CPOE group received antibiotics within 60 minutes of TOP. Mean time from TOP to antibiotic administration post-CPOE was 155.9 ± 105.5 minutes. The largest delay from TOP to antibiotic administration post-CPOE was the time between TOP and antibiotic order (105 ± 109 minutes), and time from order to pharmacy verification was shortest compared to pre-CPOE data (7.2 ± 6 minutes vs 52 ± 46.8 minutes).

CPOE implementation significantly reduced time from antibiotic order to administration in inpatients with severe sepsis or septic shock. Barriers to be addressed to aid in reaching the SSC goal and to reduce time from TOP to antibiotic order include code sepsis implementation, staff education regarding antibiotic availability on override from automated dispensing cabinets and use of pre-built sepsis order sets.