Ensuring administration of first dose of antibiotics within the golden hour of management in neonates with sepsis

BMJ Open Quality

article

Somosri Ray¹  Venkataseshan Sundaram¹  Sourabh Dutta¹  Praveen Kumar¹ 

[1] Pediatrics , Post Graduate Institute of Medical Education and Research

关键词: quality improvement;    sepsis;    antibiotic management;   

DOI  :  10.1136/bmjoq-2021-001365

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Administration of first dose of antibiotics within the golden hour in infants with sepsis is critical. Delays can increase mortality. During our observations as part of antibiotic stewardship programme in inborn neonatal unit, we found a significant delay in the administration of first dose of antibiotics from the decision time. We set up a quality improvement team to improve the proportion of neonates with sepsis, who received first dose of antibiotics within 1 hour of decision, from 0% to 80% over 2 months.We included inborn neonates requiring initiation or upgradation of antibiotics for a diagnosis of sepsis, from 1 May to 30 November 2018. We assessed the root causes behind delayed administration and found the lack of immediate availability of blood culture bottles, lack of awareness and busy clinical area as the major contributors to the delays in first dose. Various change ideas like ensuring prior availability of blood culture bottles, sensitising nursing staff and resident doctors, utilisation of hospital attendants and sharing responsibility of drawing culture between team members were tested through plan–do–study–act (PDSA) cycles.The proportion of neonates receiving first dose of antibiotics within 1 hour increased from 0% to 91% over the study period and was sustained at 92% after 6 months. There was a significant reduction in median (IQR) time interval between decision and first dose from 120 (100–290) to 45 (30–60) min (p<0.001) and after 6 months, it further decreased to 30 (30–45) min. We achieved significant improvement in administration of first dose of antibiotics within 1 hour of decision, by using system analysis and testing change ideas in sequential PDSA cycles.quality improvementsepsisantibiotic managementData availability statementAll data relevant to the study are included in the article.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

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