Akangire Gangaram, Simpson Elizabeth, Weiner Julie, Noel-MacDonnell Janelle, Petrikin Joshua, Sheehan Michael
Section of Neonatology, Children's Mercy Kansas City, University of Missouri-Kansas City.
Adv Neonatal Care. 2020 Feb;20(1):25-32. doi: 10.1097/ANC.0000000000000668.
Utilization of the neonatal sepsis calculator published by Kaiser Permanente is rapidly increasing. This freely available online tool can be used in assessment of early-onset sepsis (EOS) in newborns 34 weeks' gestation or more based on maternal risk factors and neonatal examination. However, many hospitals lack standard guidelines for its use, leading to provider discomfort with practice change.
The goal of this project was to study the antibiotic use rate for EOS at a level III neonatal intensive care unit and create standardized guidelines and staff education for using the sepsis calculator. Our ultimate goal was to decrease antibiotic use for EOS in newborns 34 weeks' gestation or more.
A standard quality improvement Plan-Do-Study-Act (PDSA) model was utilized with a plan to study the problem, implement the intervention, and test again for improvement. The primary outcome of interest was a decrease in the use of antibiotics for EOS in neonates 34 weeks' gestation or more.
Over a 4-month period, prior to sepsis calculator implementation, antibiotic use for suspected EOS was 11% and blood culture was done on 14.8% of live births. After implementation of the sepsis calculator and completion of the PDSA cycle, sepsis calculator use was greater than 95%, antibiotic use dropped significantly to 5% (P = .00069), and blood culture use dropped to 7.6% (P = .00046).
Staff education and systematic intervention using a PDSA model can significantly impact patient care, decreasing the administration of antibiotics to infants at risk for sepsis.
Future research is needed to decrease antibiotic use in premature infants less than 34 weeks' gestation with similar risk factors and clinical features.Video Abstract available at https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=34&autoPlay=true.
凯撒医疗机构发布的新生儿败血症计算器的使用正在迅速增加。这个免费的在线工具可用于根据母亲的风险因素和新生儿检查来评估孕周34周及以上新生儿的早发型败血症（EOS）。然而，许多医院缺乏使用该工具的标准指南，导致医疗人员对实践改变感到不适。
本项目的目标是研究一家三级新生儿重症监护病房中EOS的抗生素使用率，并制定使用败血症计算器的标准化指南和员工培训方案。我们的最终目标是减少孕周34周及以上新生儿EOS的抗生素使用。
采用标准的质量改进计划-实施-研究-改进（PDSA）模型，计划研究问题、实施干预措施并再次测试以进行改进。主要关注的结果是孕周34周及以上新生儿EOS抗生素使用的减少。
在4个月的时间里，在败血症计算器实施之前，疑似EOS的抗生素使用率为11%，14.8%的活产儿进行了血培养。在实施败血症计算器并完成PDSA循环后，败血症计算器的使用率超过95%，抗生素使用率显著降至5%（P = .00069），血培养使用率降至7.6%（P = .00046）。
员工培训和使用PDSA模型的系统干预可显著影响患者护理，减少对有败血症风险婴儿的抗生素给药。
未来需要开展研究，以减少孕周小于34周、具有类似风险因素和临床特征的早产儿的抗生素使用。视频摘要可在https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=34&autoPlay=true获取。
