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Improving Antibiotic Administration Time in At-Risk Pediatric Populations: A Quality Improvement Project
Insights
This quality improvement initiative successfully reduced the time to administer antibiotics for pediatric patients with sepsis. The study ensured over 80% of high-risk children received critical antibiotics within 60 minutes, improving patient safety.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Infectious Disease Management
Background:
- Bacterial sepsis poses a severe threat to pediatric patients with sickle cell disease, oncological disease, or neutropenia presenting with fever.
- Timely antibiotic administration is crucial for these high-risk patients, yet many hospitals struggle to meet the 60-minute benchmark.
- Delays in treatment can lead to adverse outcomes, highlighting the need for effective interventions.
Purpose of the Study:
- To implement and evaluate a quality improvement initiative to increase the proportion of high-risk pediatric patients receiving antibiotics within 60 minutes of emergency department registration.
- To achieve at least 80% compliance with the 60-minute antibiotic administration goal for pediatric sepsis patients.
- To identify key drivers for sustained improvement in timely antibiotic delivery.
Main Methods:
- A Plan-Do-Study-Act (PDSA) model was employed for the quality improvement initiative.
- Data were collected via electronic medical record audits, focusing on the time from emergency department registration to antibiotic administration.
- Statistical analysis, including a 2-proportion z-test using SPSS 27, was used to assess improvements in the time to antibiotics.
Main Results:
- The initiative demonstrated a significant improvement in timely antibiotic administration for pediatric sepsis patients between January 2022 and May 2024.
- The proportion of patients receiving antibiotics within 60 minutes increased from 44.4% to 86.7% overall.
- Specific improvements were observed in oncology patients (45.2% to 90%), hematology patients (42.9% to 81.6%), and sickle cell disease patients (44% to 85.1%).
Conclusions:
- The quality improvement initiative successfully enhanced the promptness of antibiotic administration for pediatric sepsis.
- By May 2024, 86.7% of patients received antibiotics within the target 60 minutes, with projections indicating 95% by 2024.
- Empowering nursing staff and implementing team-based strategies were critical factors in achieving and sustaining these positive outcomes, leading to safer patient care.
Introduction:
Bacterial sepsis is a life-threatening concern for pediatric patients with a history of sickle cell disease, oncological disease, and/or neutropenia who present with fever. Prompt antibiotic administration is critical. However, studies show that many hospitals fail to meet the 60-minute benchmark for high-risk patients, despite its known benefits.
Methods:
This quality improvement initiative aimed to ensure that at least 80% of the target population received antibiotics within 60 minutes of emergency department registration. The Plan-Do-Study-Act model was used, and data were collected through electronic medical record audits, measuring time to antibiotics from registration to administration. SPSS 27 and a 2-proportion z-test analyzed time to antibiotics improvement.
Results:
Pre- (n = 137) and postintervention groups (n = 638) were demographically similar. The mean age was 6.5 years before and 7.4 years after intervention, with a balanced sex distribution. Most patients were Black or African American, with clinical presentations including hematology with fever (9.6%), oncology with fever (40.4%), or sickle cell disease with fever (50%). Significant improvement was noted in the proportion of targeted patients receiving antibiotics in <60 minutes between January 2022 and May 2024. The time to antibiotics within goal of patients with oncology improved from 45.2% to 90%, patients with hematology from 42.9% to 81.6%, and patients with sickle cell disease from 44% to 85.1%. Overall time to antibiotics improved from 44.4% to 86.7%.
Discussion:
The initiative significantly improved timely antibiotic administration. By 2024, 95% of patients received antibiotics within 60 minutes. Enhanced nursing autonomy and team-based strategies were key drivers of success, promoting safer care and sustained quality improvement.
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