Abstract:
Prompt antibiotic treatment is essential in neonatal sepsis. NICE guidelines recommend administering antibiotics within one hour (the ‘golden hour’) of the decision to treat. Following local guidelines, for babies with two or more risk factors present at birth, the decision to treat is defined as the time of birth. This project aims to increase the proportion of these high-risk neonates receiving their antibiotics within one hour to 60% by December 2025.
Retrospective data collection was done from manual review and electronic systems. Inclusion criteria were babies born with two or more sepsis risk factors. Time of birth, antibiotic prescription and administration time, risk factors and documented reasons for delay were recorded. Staff perceptions of awareness of neonatal sepsis and delay of antibiotic administration were assessed via a Microsoft Forms survey distributed to relevant teams.
Initial interventions included regular neonatal bulletins incorporating sepsis awareness, a ‘sepsis week’ with educational displays, posters with risk factors across key clinical areas, and integration of identification of at-risk babies into the maternity huddle. Further ideas include creation of pre-prepared ‘sepsis packs’ to expedite cannulation and antibiotic administration, and improving processes for hospital number generation for timely prescribing.
Baseline data showed a median time to antibiotic administration of 2h 14m and 0% of babies meeting the golden hour. Following regular neonatal bulletins, the median time was 2h 33m which improved to 1h 46m post-sepsis week intervention. From the survey, 100% of staff reported being aware of the 1-hour target, but none felt that was ‘always’ met. Common perceptions for delay included failed cannulation (n=22), lack of hospital number (n=21) and prescribing delays (n=15).
Delay of antibiotic administration is multifactorial. There is ongoing need for increasing awareness and targeting areas of delay. Our early data shows a promising improvement following intervention and efforts are continuing.
