O0438 Oct.5: 3:46pm - Improving Timely Antibiotic Administration in Pediatric Sepsis and Septic Shock in a Pediatric Intensive Care Unit

Background:
Since 2016, our hospital joined the Improving Pediatric Sepsis Outcomes (IPSO) initiative, a national effort to improve pediatric sepsis care by incorporating bundled standardized care into the Emergency Department, Inpatient and Pediatric Intensive Care Unit (PICU) settings. Early administration of antibiotics is a hallmark of appropriate sepsis care. Delay in antibiotic administration correlates to morbidity and mortality in pediatric patients. Our PICU baseline time from antibiotic order to administration (AOTA) was 82 minutes.

Objectives:
We aimed to reduce time from antibiotic order to delivery by 20% in patients with severe sepsis or septic shock in our tertiary care PICU over 6 months.


Methods:
Prior to institution of interventions, we performed a baseline knowledge assessment of priorities in sepsis care of bedside PICU nurses. A multidisciplinary team developed multiple PDSA interventions starting with utilization of a ‘first dose magnet’ to alert nurses that a new antibiotic had been delivered to the bedside. Our second intervention was institution of a bedside physician-to-nurse paper handoff plainly stating diagnosis of ‘sepsis’, outlining goals to administer early antibiotics and fluid resuscitation, identifying physiologic goal parameters (urine output, mean arterial pressure), and encouraging early communication should goals not be met. To assist implementing a culture of change, regular education to nurses and physicians was provided as didactic lectures, emails, and signage within the PICU. We also developed a method to facilitate rapid vascular access using a specialized vascular access team that prioritized consults for sepsis patients. During the implementation period, we tracked utilization of all tools developed.


Results:
Between January 2017-December 2019, we reviewed 119 pediatric patients with severe sepsis or septic shock admitted to the PICU who were administered a first or new antibiotic. Baseline data (N=76) identified a mean time from antibiotic order to administration of 82 minutes, with 43% occurring in less than 60 minutes. After interventions, mean administration (N=43) improved to 42 minutes with 79% occurring in less than 60 min. Utilizing ongoing run chart analysis, this improvement was sustained over the following 16+ month period.

Conclusions:
Institution of education, job aids/check lists, and operational interventions aimed at improving timely administration of antibiotics was successful with a >40% improvement in time from order to administration. Improvement remained sustainable for > 16 months with decreased variability.