Timely Antibiotics Administration: Impact of Clinical Process on Barriers Delaying Time to Antibiotic Administration in Septic NICU Patients

A retrospective chart review identifying potential barriers to timely antibiotic administration was performed on 51 individual patients who presented with clinical sepsis in 2017- 2018. Prior to the education and implementation of the clinical process in Fall 2018, a survey was conducted to obtain a baseline measurement of knowledge among the RN's within the NICU at the selected implementation site. Based on the identified potential barriers, a clinical process was created and piloted in the NICU during a septic workup to overcome potential delays in antibiotic administration. The final step included a retrospective chart review using the same variables on patients who presented with clinical sepsis as a way to evaluate improvement in timely antibiotic administration. During the 6-week clinical process pilot, 19 patients required a septic workup for possible sepsis. A chi squared test was completed comparing the pre and post septic workup process chart reviews. A change occurred in patients receiving antibiotics within 60 minutes from ordering/obtaining blood cultures which increased from 22% to 31% (p-value = 0.385) not statistically significant. A more significant change was seen in patients within 120 minutes, increasing from 59% to 84% (p-value = 0.0465). Results of this study provide evidence that a septic guideline can greatly affect timely antibiotic administration and impact the care of an infant with suspected sepsis in the NICU. Due to time constraints and multiple institutional barriers to project implementation, further study is recommended to determine if the septic workup clinical process will continue to be effective in overcoming barriers to timely antibiotic administration.