Great question, Patricia! I would also be really interested to see how others weigh in on this.
It has been the practice where I have worked that the first dose of anything broad spectrum has been enough to check the box. However, checking the box and treating the patient are not the same. If more than one abx is indicated for a problem, I firmly believe that the whole first treatment (i.e. first dose of both/all 3) should be needed to "get credit". The goal, after all, is that the patient receives early goal-directed therapy...and, maybe I am wrong, but I don't think that half or a third of the treatment really qualifies. Sam -- Sam Farrell, RN CCRN Intensivist Program Manager West Coast Critical Care Specialists office: 805.988.7004 fax: 805.988.7101 cell: 805.444.3730 *wcintensivist.com* <http://wcintensivist.com/> *CONFIDENTIALITY NOTICE : This message and any included attachments are intended only for the addressee and may contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail. Thank you.* On Mon, Aug 4, 2014 at 6:59 PM, Walker, Patricia Ann < [email protected]> wrote: > Hello, > > > > Based on our patient population (elderly and SNF) , our hospital tends to > frequently utilize Vancomycin. We are seeing cases were Vanco is > administered in the ED after Blood cultures were drawn but administration > is still within 3 hours of TOP, also a combination of broad spectrum > antibiotics are administered but not within 3 hours of TOP. The addition > of the second agent has been determined by a physician’s judgment of the > patient’s severity of illness. > > > > My question is based on literature where combination therapy is advocated > in critically ill patients with severe sepsis or septic shock. > > > > My question: Can we answer yes for meeting the bundle based on the fact > that Vanco was given within 3 hours of TOP, and a broad spectrum antibiotic > was also administered, but the broad spectrum antibiotics of the TOP 3 hour > window. > > > > > > > > Some literature found > > > > Antibiotic therapy should be narrowed to target the isolated pathogen when > culture results become available. Patients who have milder forms of > infection may be more appropriately treated with narrow spectrum agents and > > antibiotic choices in these patients should be based upon current > guidelines and clinical judgment. De-escalation to a single active agent is > *strongly > *recommended when culture and susceptibility results return. > > > > 4. *C. difficile *colitis should be treated with enteral antibiotics > > if tolerated. Oral Vancomycin is preferred for severe disease > > (grade 1A). > > > > *Rationale. *In adults, metronidazole is a first choice; however, > > response to treatment with *C. difficile *can be best with enteral > > Vancomycin. In very severe cases where diverting ileostomy or > > colectomy is performed, parenteral treatment should be considered > > until clinical improvement is ascertained (539–541). > > > > > > Thank you, > > Patricia Walker, RN-BC. BSN > > Evidence Based Practice Manager > > 924 Westwood Blvd., Suite 900 Los Angeles, CA 90095 > > T 310.794.8522 F 310.794.3284 > > *"The character of a nurse is just as important as the knowledge he/she > possesses."* > * - Carolyn Jarvis* > > > > > > ------------------------------ > > IMPORTANT WARNING: This email (and any attachments) is only intended for > the use of the person or entity to which it is addressed, and may contain > information that is privileged and confidential. You, the recipient, are > obligated to maintain it in a safe, secure and confidential manner. > Unauthorized redisclosure or failure to maintain confidentiality may > subject you to federal and state penalties. If you are not the intended > recipient, please immediately notify us by return email, and delete this > message from your computer. > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >
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