Team work is required to meet the goals for prompt intervention. The prompt administration of antibiotics should be considered as important as intubation, fluid and vasopressors, and will require the help of coworkers. Tips to help meet our goals include:
At admission, one person should volunteer to collect cultures while a second person prepares antibiotics for administration. This should happen at the same time as interventions to correct alterations in airway, breathing and circulation.
Attempt to get cultures before antibiotics are administered, however, if cultures cannot be collected immediately, do not delay administration of antibiotics.
Do not wait for the insertion of intravascular lines to collect blood cultures: obtain cultures via peripheral sampling and then initiate antibiotics. If you cannot obtain a peripheral culture, do not delay antibiotic initiation.
Give beta lactam antibiotics first (penicillins, cephalosporins, meropenem/imipenem): they can be can administered in a 50 ml minibag and given as rapidly as possible (thus, getting one antibiotic "in the patient" quickly). Piperacillin/Pip tazo should be given over 30 minutes.
If you have more than one access site, 2 or 3 antibimicrobials can be hung simulatenously.
Do not wait for "regular times"; give antibiotics STAT and stagger times over several doses if desired.