Page 120 - Best practice_Oral2024 (อัพเดต)

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is activated by the screening nurse at the triage area of the ED. A physician on duty then
promptly examines the patient; if the physician's provisional diagnosis is sepsis, the intravenous
(IV) antibiotic will be ordered and sent to the hospital pharmacy. When the antibiotic

is dispensed, the nurse checks and administers it to the patient; all of the laboratory requested
by the physician is drawn before it is administered. The timer is stopped when the first drop
of Intravenous antibiotic is given to the patient, and the time is automatically recorded to the
sepsis registry system for analysis. The recorded time includes: 1. Waiting time is the patient's

waiting duration to be examined by a physician; 2. Physician Examination and Diagnosis Time
is the duration that a physician examines, makes the diagnosis, and orders the antibiotic via
the hospital information system; 3. Dispensing time is the duration between the time that the
physician orders the antibiotic and the hospital pharmacy dispenses the antibiotic to the nurse;

4. Administration time is the duration between the nurse receiving the antibiotic from the
hospital pharmacy and the patient being administered the antibiotic. The in-charge nurse is
responsible for clicking the record button when completing each process.

ผลการศึกษา
Between April 2023 and September 2023, 330 septic patients presented to the

Emergency Department, 11 patients were excluded due to transferal from another area of the
hospital, 319 patients were prospectively enrolled in the study, including 164 patients in the
pre-implementation period, and 155 patients in post-implementation period. The overall
mortality is 121 patients (38%)

Demographics include a median age of 66 and a median SOS Score of 6 (IQR 4-8).
The most common source of infection is Pneumonia (43.3%), urinary tract infection (12.2%),
and Gastrointestinal (10.7%). The percentage of septic shock patients is 32.3%. Comparing the

pre and post-implementation process, no significant differences were observed in the number
of patients, age, gender, source of infection, percentage of septic shock, and type of admission.
To compare the average Time to antibiotics, the pre-implementation process time
is 54 minutes (SD=35.6), and the post-implementation process time is 34 minutes (SD=19.5)
(p= 0.0315). The average time in each process is significantly lower in the Post-implementation

group.
The in-hospital mortality rate is significantly improved in the Post-implementation
group compared to the Pre-implementation group, with average mortality rates of 29%

and 45% (p= 0.029).