79 - Improving birth to antibiotics administration time in extremely low birth weight: A quality improvement project

Poster Number: 79
Publication Number: 79.3290

Background: Prompt initiation of appropriate antimicrobial therapy against causative pathogens has been shown to be an important predictor of clinical outcomes. In neonates specifically, early initiation of anti-microbial therapy with a goal of less than 60 minutes significantly reduces sepsis related mortality. In the Cleveland Clinic Children’s NICUs (Neonatal Intensive Care Units), analysis of the baseline data in extremely low birth weight infants (ELBW) demonstrated an average time of antibiotic administration of 189 minutes of life. A Golden Hour guideline was implemented in the second quarter of 2022. Monitoring adherence to the standard guidelines and identifying barriers is essential to develop processes and structures to enable our caregivers to optimize timing of antibiotic administration.

Objective: The aim of the project was to increase adherence to golden hour recommendations for ampicillin administration within the first 60 minutes of life from 0% to > 80% by the end of 2026 in VLBW infants, with 20% increase each year.

Design/Methods: Standardized guidelines for the “golden hour” in ELBW were established by an organized, multidisciplinary team. Baseline data were collected on adherence to the “golden hour” with the time of ampicillin infusion being our objective data. Cause-effect analysis was undergone in the form of a fishbone diagram and process map, which identified targeted areas for improvement: 1- Simplify, and standardized weight and measurements required for admissions. 2- Saved electronic order-set to providers for fluids and antibiotics, with goal to get order in by 20 minutes of life and 3- An apparent cause analysis for all birth to ampicillin times greater than double our target time. Average birth to ampicillin time and lowest time was presented to all staff monthly.

Results: Analysis of the baseline data from January 2020 to March 2022 demonstrated 0% of VLBW with antibiotics started by 60 minutes of life, with average time of 189 minutes. Average birth to ampicillin time decreased after each PDSA cycle with the most substantial decrease of 97 minutes after implementation of a customized order set.

Conclusion(s): A goal to expedite antibiotics administration in ELBW can be improved with adherence to a standardized guideline, utilization of quality improvement methodology, and multidisciplinary teamwork approach.