What barriers or facilitators might influence the implementation of antibiotics (abx) within 60 minutes?

From the Guidelines

Implementing antibiotic administration within 60 minutes of recognition is crucial, and barriers to this goal include delayed recognition of sepsis, inadequate triage protocols, and operational complexities in the drug delivery chain, while facilitators such as electronic alert systems, standardized order sets, and dedicated sepsis response teams can improve timely administration 1.

Barriers to Implementation

Barriers to implementing antibiotic administration within 60 minutes include:

• Delayed recognition of sepsis
• Inadequate triage protocols
• Overcrowded emergency departments
• Staffing shortages
• Lack of readily available antibiotics
• Delays in obtaining cultures
• Complex approval processes
• Insufficient education about sepsis urgency

Facilitators of Implementation

Facilitators that can improve timely administration of antibiotics include:

• Electronic alert systems that flag potential sepsis cases
• Standardized order sets
• Dedicated sepsis response teams
• Point-of-care testing for faster diagnostics
• Readily available antibiotic kits in critical areas
• Continuous staff education
• Regular performance feedback
• Leadership support with clear accountability
• Physical layout improvements in emergency departments and pharmacies

Recommendations for Improvement

To improve the implementation of antibiotic administration within 60 minutes, institutions should assess the causes of delays and implement quality improvement initiatives, including defined order sets, and consider establishing a supply of premixed drugs for urgent situations 1. Additionally, improving communication among medical, pharmacy, and nursing staff can also be highly beneficial. Successful implementation requires addressing barriers while leveraging facilitators through a multidisciplinary approach that combines technological solutions with workflow optimization and cultural change to prioritize rapid antibiotic delivery in suspected sepsis cases.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Barriers to Implementation of Antibiotics within 60 minutes

• The need for rapid investigation to minimize the risk of overtreatment and antibiotic-associated harms for patients who are not infected 2
• The risk of unintentional exposure to broad-spectrum antibiotics in patients without infection, which may increase with strict time thresholds for antibiotic administration 3
• The potential for antibiotic overuse and resistance, particularly with empiric broad-spectrum therapy 4
• The challenge of balancing the need for immediate antibiotics with the need for accurate diagnosis and appropriate treatment 2

Facilitators to Implementation of Antibiotics within 60 minutes

• The use of multidisciplinary teams and staff education to improve prioritization and efficiency of care 5
• The implementation of best practice alerts, order sets, and standardized huddle responses to streamline antibiotic administration 5
• The use of premixed antibiotic bags, such as a combination of cefepime and vancomycin, to increase compliance with Surviving Sepsis Campaign recommendations 6
• The availability of biomarkers, such as procalcitonin, to guide antibiotic use and de-escalation 4
• The commitment to antimicrobial stewardship to minimize the risk of antibiotic overuse and resistance 4