Objective: A sepsis protocol including institution-specific antibiotic recommendations based on local susceptibility patterns was implemented at our institution. The purpose of this investigation was to determine the impact of these recommendations on the adequacy of initial empiric therapy in patients with severe sepsis admitted to the intensive care unit. Methods: This was a single-center, retrospective, observational study conducted in a medical intensive care unit at a university-affiliated medical center. Charts of patients identified as having sepsis in our sepsis database from November 2004 to September 2006 were retrospectively reviewed. Adequacy of initial therapy was assessed, as were the number of antibiotics used per patient and 28-day mortality. Results: One hundred nine patients met inclusion criteria for the evaluation. Thirty-eight patients were in the pre-protocol group and 71 patients were in the post-protocol group. Adequacy of initial therapy increased from 68% pre protocol to 85% post protocol (P , 0.05). A secondary analysis showed that if antibiotic recommendations had been followed exactly according to protocol, the number of antibiotics per patient would decrease from 2.47 to 2.11 (P 5 0.017) without changing adequacy of initial treatment. Conclusion: Implementation of a sepsis protocol containing institution-specific antibiotic recommendations was associated with an increased percent of patients receiving adequate empiric antibiotic therapy. Strictly adhering to the institution-specific antibiotic recommendations could result in fewer antibiotics used per patient without reducing the adequacy of empiric treatment.
Background: Preceptor development is a focus of pharmacy residency programs across the country. Graduation from residency into the role of preceptor can be a challenge, as it is one of many transitions junior practitioners make in their early careers. Literature in recent years has brought attention to the need to establish preceptor development programs that adequately allow newer preceptors to develop their skills in experiential education, for both pharmacy residents and students. Furthermore, many preceptor development programs as implemented are often didactic in nature, and include readings, webinars, and other passive learning regarding the art of precepting. Objective: Given the need to develop a preceptor development program in our service line that met the needs of preceptors-in-training and full preceptors, we offer a description of our preceptor development program in the intensive care unit. Methods: We focused on active development of preceptor skills for multiple layers of resident and student learners. In addition, this model incorporated instructing, modeling, coaching, and facilitating, as the relationship between full preceptor and preceptor-in-training evolved. It also offered the opportunity for real-time feedback and discussion on precepting performance. Conclusions: We describe our coprecepting model as an opportunity that succeeded for us in helping to transition our preceptors-in-training to full preceptors. It met the needs of our department, staff, and patients, and we believe it has the potential to be valuable as a tool extrapolated to the preceptor development programs of other institutions.
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