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Improving the timing of antibiotic administration to high-risk newborns
G M Weiner1, J D Barks, E J Wright
1Department of Pediatrics, University of Michigan, Ann Arbor 48109-0254, USA.
Insights
Prompt administration of parenteral antibiotics to newborns with suspected sepsis is crucial. Interventions significantly improved timely antibiotic delivery, reducing delays and enhancing infant care.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Healthcare Quality Improvement
Background:
- Delayed administration of parenteral antibiotics in newborns with suspected sepsis is a common issue.
- Timely antibiotic initiation is critical for improving outcomes in neonatal sepsis.
Purpose of the Study:
- To determine the timing of parenteral antibiotic administration for infants with suspected sepsis at birth.
- To identify barriers hindering prompt antibiotic delivery.
- To evaluate the effectiveness of interventions aimed at reducing these barriers and improving compliance with timing goals.
Main Methods:
- Retrospective chart review and prospective interventions involving 488 infants with suspected sepsis at birth.
- Initial audit to identify compliance gaps, followed by implementation of unit policies and educational programs.
- Continued surveillance and individual feedback to caregivers after initial interventions.
Main Results:
- Before interventions, only 28% of infants received antibiotics within 1 hour of physician order and 19% within 2 hours of birth.
- Following interventions, compliance increased to 87% within 1 hour of order and 92% within 2 hours of birth (p < 0.0001 for both).
- Mean administration times significantly decreased from 1.58 hours to 0.79 hours post-order and from 3.12 hours to 1.26 hours post-birth.
Conclusions:
- Parenteral antibiotic administration for suspected neonatal sepsis is often delayed beyond recommended timeframes.
- Targeted interventions, including policy changes, education, and feedback, significantly improved the timeliness of antibiotic delivery.
- Continuous quality improvement efforts are essential for maintaining and further optimizing antibiotic administration timing in neonatal care.
Objectives:
To describe the timing of initiation of administration of parenteral antibiotics to infants with suspected sepsis at birth, identify barriers to prompt administration, and assess the effectiveness of subsequent interventions designed to minimize these barriers. The goals were to administer antibiotics within 1 hour of the physician order and within 2 hours of birth with more than 80% compliance for both goals.
Study Design:
Retrospective chart review and prospective interventions involved 488 infants born at the University of Michigan Medical Center with indications for antibiotic therapy at birth. After an initial audit of the charts of 56 infants and the identification of poor compliance with the goals, unit policies and educational programs were developed to facilitate timely antibiotic administration. After a second audit demonstrated improvement but failure to attain the target compliance rates, review of individual cases with the responsible physician and nurse was initiated. Time intervals between birth, writing the order for antibiotics, noting the order by the nurse, and administration of antibiotics were tracked for an additional 20 months after these interventions.
Results:
Before the interventions, antibiotics were administered to 28% of infants within 1 hour of the physician order (mean +/- SEM 1.58 +/- 0.11 hours) and to 19% within 2 hours of birth (3.12 +/- 0.16 hr). By the conclusion of the study, antibiotics were administered to 87% (p < 0.0001) of infants within 1 hour of the physician order (0.79 +/- 0.04 hour; p < 0.001) and to 92% (p < 0.0001) within 2 hours of birth (1.26 +/- 0.06 hours; p < 0.001).
Conclusions:
Administration of the first dose of parenteral antibiotics to newborns with suspected sepsis at birth frequently takes more than 1 hour after the order is written and more than 2 hours after birth. Efforts to identify and minimize common barriers significantly improved the timing of antibiotic administration. Additional improvement was attained by means of continued surveillance and individual feedback to caregivers of infants when timing objectives were not fulfilled.