Full Answer Section

• Time of First Antibiotic Order: The time the physician or clinical officer ordered the initial broad-spectrum antibiotics. This is taken from the physician order sheet or the EMR order entry system.
• Time of First Antibiotic Administration: The exact time the first dose of the ordered antibiotic was administered to the patient. This is typically recorded by the nursing staff in the medication administration record (MAR) in the patient’s chart (paper or EMR).
• Type of Antibiotic Administered: The specific name of the antibiotic.
• Patient Outcome (short-term): Whether the patient was discharged, transferred, or expired. This is obtained from the discharge summary or patient disposition records.

The data is primarily taken from:

• Emergency Department (ED) Triage Logs/Registration Systems: For arrival times.
• Patient Medical Records (Paper Charts or EMR): Physician notes, nursing notes, medication administration records, and order sheets.
• Laboratory Results: To confirm infection markers (e.g., lactate, white blood cell count, procalcitonin) which support sepsis diagnosis criteria.

Who is responsible for data collection, analysis, and reporting?

• Data Collection:
  • Frontline Nurses: Primarily responsible for accurately documenting arrival times, symptom onset, time of antibiotic administration, and other relevant clinical data in the patient’s chart/EMR.
  • Clinical Officers/Medical Officers: Responsible for documenting sepsis recognition time and antibiotic order times.
  • Dedicated Data Clerks/Quality Improvement Staff: Often review charts retrospectively or extract data from the EMR for aggregation.
• Data Analysis:
  • Quality Improvement (QI) Department/Team: A dedicated team, often comprising nurses, clinical officers, data analysts, and sometimes a physician lead, is responsible for compiling the raw data, calculating the “time to first antibiotic” for each relevant patient, identifying trends, and comparing performance against internal targets or national/international benchmarks (e.g., the Surviving Sepsis Campaign’s “golden hour” recommendation).
• Reporting:
  • QI Department/Team: Prepares summary reports, dashboards, and presentations.
  • Clinical Leadership: (e.g., Head of ED, Chief Nursing Officer, Medical Director) Reviews these reports.
  • Hospital Management Committee/Board: Receives high-level reports to monitor overall quality of care and inform strategic decisions.
  • Departmental Meetings: Results are shared with frontline staff in the ED, ICUs, and medical wards for feedback and discussion.

How is the data critically evaluated to accurately reflect the desired care outcomes? Who makes the decisions to apply the data to practice change?

Critical evaluation of the “Time to First Antibiotic” data involves several steps to ensure it accurately reflects desired care outcomes:

1. Validation and Reliability Checks:
   • Auditing: Regular audits of a sample of records are conducted to verify the accuracy of documented times against actual events. Discrepancies are investigated.
   • Exclusion Criteria: Clearly defined exclusion criteria are applied (e.g., patients with documented prior antibiotic administration, patients who decline treatment, patients for whom sepsis was not the primary admission diagnosis if not relevant to the measure).