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Published on: June 11, 2012
Improving Time to Stat Intravenous Antibiotic Administration: An 8-Year Quality Initiative
Hannah Miller1,2, Ashlie Tseng1,2, Tracy Lowerre2
1Division of Hospital Medicine.
Insights
Timely antibiotic administration for pediatric sepsis improved significantly through quality improvement initiatives. This involved multiple interventions to speed up stat intravenous antibiotic delivery in children.
Area of Science:
- Pediatric critical care
- Quality improvement science
- Infectious disease management
Background:
- Pediatric sepsis remains a significant cause of child mortality globally.
- Prompt antibiotic administration is crucial for improving outcomes in pediatric sepsis.
- This study details quality improvement efforts at a children's hospital to enhance antibiotic timeliness.
Purpose of the Study:
- To describe quality improvement (QI) initiatives aimed at improving the timeliness of stat intravenous (IV) antibiotic administration in pediatric sepsis.
- To report on the sustained impact of these QI efforts over an eight-year period.
Main Methods:
- Utilized electronic health records to track time from order to administration of stat IV antibiotics (2012-2020).
- Implemented multiple QI interventions including a dedicated sepsis committee, automated dispensing, standardized order sets, sepsis screening, national collaborative participation, difficult IV access guidelines, and automated nurse notifications.
- Monitored stat IV antibiotic use relative to emergency department visits and inpatient days as a balancing measure.
Main Results:
- Achieved a substantial improvement in the administration of stat IV antibiotics within 1 hour of order, increasing from 33% in 2012 to 77% in 2019.
- Sustained this improved performance through July 2020.
- Demonstrated consistent and sustained improvement in timely antibiotic administration.
Conclusions:
- A multipronged quality improvement approach effectively enhanced the timely administration of stat IV antibiotics in pediatric sepsis.
- Further research is warranted to determine the association between improved antibiotic timeliness and clinical outcomes such as reduced length of stay and enhanced survival rates in pediatric sepsis patients.
Background And Objectives:
Prompt antibiotics have been shown to improve outcomes in pediatric sepsis, which continues to be a leading cause of death in children. We describe the quality improvement (QI) efforts of a single academic children's hospital to improve antibiotic timeliness.
Methods:
Using the electronic health record, we report time from order to the administration of stat intravenous (IV) antibiotics from 2012 to 2020 using statistical process control charts. We describe QI interventions initiated over the study period. These include the formation of a Pediatric Sepsis Committee, routine use of automated dispensing machines for stat IV antibiotics, creation of sepsis order sets, manual and automated sepsis screening implementation, participation in national sepsis QI collaboratives, creation of difficult intravenous access guidelines, and an automated notification system for charge nurses. As a balancing measure, we assessed stat IV antibiotic use normalized to total emergency department visits and inpatient days.
Results:
Multiple quality improvement interventions were initiated and sustained under the direction of the hospital Pediatric Sepsis Committee. We improved our stat IV antibiotics given within 1 hour of order from 33% in 2012 to 77% in 2019 and maintained this through the end of the study period in July 2020.
Conclusions:
By using a multipronged quality improvement approach, we demonstrated consistent and sustained improvement in the timely administration of stat IV antibiotics over an 8-year period at our institution. Further study is needed to assess whether this is associated with reduced length of stay or improved survival in children with sepsis.
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