Faster administration of antimicrobials in sepsis team quality improvement initiative in the intensive care unit: a retrospective audit (FAAST-R)

Objectives The primary objective of this audit was to evaluate adherence to guideline-recommended timeframes for first-dose antimicrobial administration among adult intensive care unit (ICU) patients at the McGill University Health Centre, encompassing patients with infections without sepsis and those with possible sepsis or septic shock. Methods In a retrospective audit, patients admitted for >48 h in three adult ICUs who were prescribed pre-selected antimicrobials were evaluated. The time elapsed between each successive step in the interval between prescription and administration was assessed. The effects of pre-identified system-, provider-, and patient-related factors on the timely administration of antimicrobials were examined using univariate logistic regression in patients with sepsis or septic shock (≤60 min) and those without (≤180 min). Key findings Two hundred fifty-one patients were included in the analysis. In patients with sepsis or septic shock, antimicrobials were administered in the recommended timeframe (≤60 min) in 54% of cases, whereas 78% of patients without sepsis received antibiotics in a timely fashion (≤180 min). Of all process intervals examined, increasing time between pharmacist validation of the prescription and medication administration was significantly associated with reduced odds of timely antimicrobial administration. Ongoing continuous renal replacement therapy significantly decreased the odds of timely antimicrobial administration. Conclusions Suboptimal adherence to the recommended antimicrobial timing was observed, especially in patients with possible sepsis or septic shock. Additional factors that may influence a timely administration of antimicrobials in this context should be further investigated prospectively.