Abstract:
1. Background: Neonatal sepsis is a time-critical condition in which delays in antibiotic administration are associated with increased morbidity and mortality¹. Guidance from the National Institute for Health and Care Excellence and the British Association of Perinatal Medicine recommends intravenous antibiotics within one hour of clinical decision (“golden hour”)²,³. This audit evaluated compliance with this standard and identified key points of failure within a tertiary neonatal network.
2. Methods: A retrospective audit was conducted over two months (November-December 2025). All neonates commenced on intravenous antibiotics for suspected sepsis were identified using the electronic clinical record system (BadgerNet) and cross-checked with drug administration records. Recorded timepoints included sepsis screening, clinical decision-to-treat, antibiotic prescription, and administration. The primary outcome was antibiotic delivery within 60 minutes of decision. Secondary analysis examined decision-to-prescription and prescription-to-administration intervals to identify bottlenecks. Descriptive statistics and subgroup analysis by clinical area were performed. Early Plan-Do-Study-Act interventions targeted escalation pathways and prescribing workflow reliability?.
3. Results: Twenty-six neonates met inclusion criteria. Overall compliance with the golden hour standard was 65.4% (17/26); 34.6% (9/26) received antibiotics beyond one hour. In delayed cases, the mean time for antibiotics was 3.2 hours, with a maximum delay of 13.5 hours. In delayed cases, the dominant bottleneck occurred between clinical decision and antibiotic prescription, accounting for 22% of total median delay in delayed cases. Compliance varied across clinical areas, from 40% on the tertiary neonatal unit (reflecting higher clinical acuity and workflow intensity) to 66.7% in its affiliated regional neonatal unit.
4. Conclusion: Most neonatal sepsis delays occur after recognition, driven by prescribing and workflow failures rather than diagnostic delays. These findings identify a modifiable patient safety risk?. Targeted quality improvement interventions have been implemented to improve golden hour compliance. Marked inter-ward variation highlighted inconsistent escalation processes, suggesting that standardised sepsis pathways and prescribing prompts may reduce delays and improve treatment.
