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Published on: August 12, 2020
Improving timing of antibiotics in neonates with early onset sepsis - Quality improvement project
Cheng Ma1, Garret Levin1,2, Sanjeet K Panda1,2
1Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
Insights
Timely antibiotic administration for early onset sepsis (EOS) in newborns was improved through a quality improvement project, reducing infusion time from 70 to 48 minutes. This initiative successfully increased the percentage of neonates receiving antibiotics within one hour of decision-making from 37% to 77%.
Area of Science:
- Neonatal Medicine
- Quality Improvement Science
- Pediatric Infectious Diseases
Background:
- Early onset sepsis (EOS) significantly contributes to neonatal morbidity and mortality.
- Prompt antibiotic administration is critical for effective management of neonatal sepsis.
- A quality improvement project was implemented to enhance the timeliness of antibiotic delivery to neonates.
Purpose of the Study:
- To reduce the time to antibiotic administration in neonates with suspected early onset sepsis.
- To improve the overall workflow for antibiotic delivery in a neonatal intensive care unit.
Main Methods:
- The project focused on optimizing antibiotic delivery from the pharmacy and streamlining electronic medical record (EMR) admission processes.
- Data on antibiotic administration timings were collected and analyzed using control charts.
- A Plan-Do-Study-Act (PDSA) methodology was employed, comparing pre-intervention data (December 2016) with post-intervention data (January 2017-November 2018).
Main Results:
- Significant improvements were observed in the time to EMR admission across PDSA cycles (p < 0.05).
- Time for antibiotic delivery from pharmacy decreased from 21 to 9 minutes, enhancing workflow efficiency.
- Average time from decision to antibiotic infusion reduced from 70 to 48 minutes.
- The proportion of neonates receiving antibiotics within one hour of decision-making increased from 37% to 77%.
Conclusions:
- The quality improvement project successfully achieved the goal of administering antibiotics within one hour for early onset sepsis.
- A multidisciplinary approach is key to replicating these improvements in other institutions caring for newborns.
- Streamlining admission, registration, and EMR entry processes effectively reduced critical time delays.
Background And Objectives:
Early onset sepsis (EOS) is an important cause of neonatal morbidity and mortality. Timely administration of antibiotics is crucial in management. We initiated a quality improvement project to improve timely administration of antibiotics.
Methods:
Primary drivers of change identified by the team were improving delivery of antibiotics from pharmacy and improving time to admit in the electronic medical record (EMR) in order to improve overall timeliness of antibiotics administration. Timings of antibiotics administration was tracked by using a control chart. Timings of antibiotics and outcomes of pre-intervention (December 2016) were compared with post intervention of PDSA cycles (January 2017-November 2018).
Results:
There was statistically significant improvement in time to admission in electronic medical records over the time periods of pre-intervention, PDSA I and PDSA II (p-value < 0.05) (Table 1). Also, time to delivery of antibiotics from pharmacy was significantly reduced between PDSA cycles from 21 minutes to 9 minutes with improvement in overall workflow. An average time to infusion of antibiotics decreased from 70 minutes to 48 minutes. There was also overall improvement in number of neonates receiving antibiotics under 1 hour of decision making from 37% to 77%.
Conclusions:
In our study we were able to successfully implement our "antibiotics under one hour" goal. The ability to achieve this objective can be met across multi-institutions rendering care to newborns if the approach is multidisciplinary. Deleting obstructions in the process that involve admission, registration and entry into the EMR effectively reduced time.
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