Fellow Wake Forest Baptist Health - Brenner Children's Hospital Winston-Salem, North Carolina, United States
Background: Neonatal sepsis is associated with significant mortality, prolonged hospital stays, and long-term disability, including poor neurodevelopmental outcomes. Delayed time to antibiotic administration is an independent risk factor for mortality associated with sepsis. Surviving Sepsis Campaign recommends antibiotics within one hour of recognition. The implementation of a “NICU Code Sepsis Antibiotic Guideline” for infants admitted to the Brenner Children’s Hospital NICU will improve appropriate empiric antibiotic therapy, while the quality improvement initiative associated with the guidelines will improve the time of antibiotic administration for both late onset sepsis, and early onset sepsis. Objective: We sought to achieve administration of antibiotics within one hour of antibiotic order being placed and to have adherence to empiric antibiotic selection as per our “NICU Code Sepsis Antibiotic Guidelines” in 80% of cases by March 31st 2024 and sustain for at least three consecutive months. Design/Methods: A multidisciplinary team utilized the Model for Improvement for this initiative. We developed and implemented empiric antibiotic guidelines, a “Code Sepsis” order set, held educational sessions, displayed reminder signs, provided performance feedback and specific team member recognition. Data collected included birthweight, gestational age at birth, date of sepsis work up, antibiotics administered, time antibiotic ordered and administered, and cultures obtained. The process measures included compliance with using order set, ordering of antibiotics STAT, and compliance with antibiotic selection guidelines. The balancing measure was the number of blood cultures unable to be obtained prior to antibiotic administration. Results: Our baseline data showed that only 26% of patients received antibiotics within one hour, and only 16% of those were ordered stat. Through our PDSA cycles to date, patients with concern for early onset sepsis on average received antibiotics within one hour 63% of the time and patients with concern for late onset sepsis on average received antibiotics within one hour 68% of the time. Antibiotics were ordered stat on average 64% of the time for early onset and 79% for late onset sepsis.
Conclusion(s): The use of guidelines, code sepsis order set, feedback, and education are important in improving antibiotic administration time from the initial concern for sepsis. Control Chart 1.jpeg
