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A sepsis trigger tool reduces time to antibiotic administration in the NICU

Journal of Perinatology (2023)Cite this article

Subjects

Abstract

Objective

Prolonged time to antibiotic administration is associated with increased morbidity and mortality. Interventions to decrease the time to antibiotic administration may improve mortality and morbidity.

Study design

We identified possible change concepts for reducing time to antibiotic usage in the NICU. For the initial intervention, we developed a sepsis screening tool based on NICU-specific parameters. The main goal of the project was to reduce time to antibiotic administration by 10%.

Results

The project was conducted from April 2017 until April 2019. There were no missed cases of sepsis in the project period. Time to antibiotic administration for patients who were started on antibiotics decreased during the project, with the mean shifting from 126 to 102 min, a reduction of 19%.

Conclusions

We successfully reduced time to antibiotic delivery in our NICU using a trigger tool to identifying potential cases of sepsis in the NICU environment. The trigger tool requires broader validation.

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Fig. 1: Key driver diagram.
Fig. 2: Trigger tool utilization (u-chart).
Fig. 3: Percentage of positive blood cultures (p-chart).
Fig. 4: Time to antibiotic administration (X-bar/Sigma).

Data availability

All study data are available upon request by contacting the corresponding author and will be maintained for 3 years after publication.

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Funding

This work was supported by the Boston Children’s Hospital Division of Newborn Medicine and Department of Pediatrics (AEO).

Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, USA

    Avery Forget, Comfort Adegboye & Amy E. O’Connell

  2. Department of Pediatrics Quality Program, Boston Children’s Hospital, Boston, MA, USA

    Maria Alfieri, Ramy Yim & Himi Mathur

  3. Infection Prevention, Boston Children’s Hospital, Boston, MA, USA

    Kathleen Flaherty

  4. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Amy E. O’Connell

Authors
  1. Avery Forget
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  2. Comfort Adegboye
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  3. Maria Alfieri
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  4. Ramy Yim
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  5. Kathleen Flaherty
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  6. Himi Mathur
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  7. Amy E. O’Connell
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Contributions

All authors critically revised the manuscript for important intellectual content, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work. In addition: AF assisted with clinical implementation of the trigger tool and performed data collection and analysis for the study. CA performed data collection and analysis for the study. MA assisted with project management, editing the manuscript, and measuring quality-related outcomes. RY assisted with generating the analysis and generating figures and manuscript generation. KF assisted with clinical implementation of the project and clinical expertise. AEO conceptualized the project, assisted with clinical implementation, managed the project, and wrote the manuscript.

Corresponding author

Correspondence to Amy E. O’Connell.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This project was conducted according to local institutional standards for QI initiatives and therefore IRB approval was not needed. Furthermore, implementation of the pediatric age trigger tool was already hospital wide at the time of developing our tool and developing the tool for the NICU would bring the neonatal patients up to the same standard of care as the older patients in the hospital.

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Forget, A., Adegboye, C., Alfieri, M. et al. A sepsis trigger tool reduces time to antibiotic administration in the NICU. J Perinatol (2023). https://doi.org/10.1038/s41372-023-01636-1

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