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Triage Standing Orders Decrease Time to Antibiotics in Neonates in Pediatric Emergency Department

Maegan S Reynolds, Ashley Dunaway, Carrese Stevens

    Journal of Emergency Nursing
    |September 28, 2020
    PubMed

    Insights

    Implementing nurse-driven triage standing orders significantly reduced antibiotic administration time for infants with serious bacterial infections. This quality improvement initiative improved timely care for high-risk newborns in the emergency department.

    Area of Science:

    • Pediatrics
    • Infectious Diseases
    • Healthcare Quality Improvement

    Background:

    • Neonates (0-28 days) face high risks of serious bacterial infections, necessitating prompt evaluation and antibiotic treatment.
    • Current practices often result in delayed antibiotic administration, with baseline rates at 19% within 120 minutes.
    • A quality improvement initiative aimed to enhance the timeliness of antibiotic delivery for these vulnerable infants.

    Purpose of the Study:

    • To decrease the time to antibiotic administration for infants (0-28 days) evaluated for serious bacterial infections in the emergency department.
    • To increase the percentage of infants receiving antibiotics within 120 minutes of arrival.

    Main Methods:

    • A quality improvement team utilized nurse-driven triage standing orders and multiple Plan-Do-Study-Act cycles.
    • The study focused on infants aged 0-28 days undergoing evaluation for serious bacterial infections.
    • Statistical process control charts were used for data analysis.

    Main Results:

    • The implementation of triage standing orders and educational interventions led to 84% of infants receiving antibiotics within 120 minutes.
    • The average time to antibiotic administration was reduced from 192 minutes to 74 minutes.
    • Initial goals for timely antibiotic delivery were surpassed.

    Conclusions:

    • Nurse-driven triage standing orders are effective in improving timely antibiotic administration for infants with serious bacterial infections.
    • Empowering nurses to initiate work-ups fosters a joint-responsibility model, leading to sustained improvements.
    • A cultural shift towards nurse-initiated protocols enhances efficiency and patient care in the emergency department.
    Abstract

    Keywords:
    NeonatesNurse-driven ED flowQuality improvementSerious bacterial infectionTriage standing orders

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