WIP 20 - A Quality Improvement project to improve timing of antibiotic administration in Late Onset Neonatal Sepsis

Publication Number: WIP 20.7564

Tashalee McGrath-Blagrove, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Plainfield, NJ, United States; Pooja Shah, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hoboken, NJ, United States; Lauren K. Smith, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Morristown, NJ, United States; Sejal M. Bhavsar, Hackensack University Medical Center, Lyndhurst, NJ, United States; Bianca Taurozzi, Hackensack Meridian School of Medicine, Fairview, NJ, United States; Maureen Kim, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States

Background: Late onset neonatal sepsis (LOS) is associated with significant mortality in neonates. In the neonatal population there is little evidence regarding optimal timing for antibiotics. Recommendations from the Surviving Sepsis Campaign of antibiotics within 1 hour to decrease mortality in adult patients have been extrapolated to neonatal patients. Early administration of empiric antibiotics can reduce mortality and morbidity.

Objective: To reduce time to antibiotic administration in patients being treated for LOS in our neonatal intensive care unit(NICU) from 105 minutes to 75 minutes (a 30% reduction) by April 2025, with a stretch goal of reducing time to antibiotic administration to < 1 hour by December 2025.

Design/Methods: Our NICU is a level 3b, 40 bed unit which is part of an academic children’s hospital within a large medical center and integrated health network. Baseline data was collected on patients treated for LOS admitted from January 1, 2024-July 31, 2024.Variables collected include antibiotic order time, type of antibiotic, blood culture order and collection time, pharmacist verification and dispensing time, and antibiotic administration time. A multidisciplinary team, formed in August 2024, is using the Model for Improvement to design and execute the project. Process mapping and staff interviews were performed to identify gaps and opportunities for improvement. Interventions that will be tested using Plan-Do-Study-Act (PDSA) cycles include staff education, improving communication utilizing the electronic medical record (EMR), creating a LOS order set and bedside LOS checklist. The outcome measure is time from antibiotic order to administration. Process measures will include the percentage of orders with appropriate EMR communication and compliance with use of the LOS order set and checklist. Measures will be analyzed monthly using run charts. Our first PDSA is currently underway testing EMR messaging to improve communication between bedside nurses and pharmacists.