Neo-Train Quality Improvement Initiative to Improve Eosin (Early Onset Sepsis in Neonates) Care as per NICE Recommendation

Background: Neonatal sepsis is a serious systemic infection and is a leading cause of neonatal morbidity and mortality. Recognizing neonates at risk of sepsis and early identification of sepsis followed by immediate treatment is key to reducing adverse outcomes.

National Institute of Clinical Excellence guidelines on neonatal sepsis recommends administration of antibiotics within 1 hour of suspecting sepsis. Achieving this target can be challenging in a busy NICU. Adult and pediatric services have addressed this by introducing 1-hour sepsis care bundles.

Aim: To improve adherence to NICE sepsis standard for administration of antibiotics within 1 hour of suspecting sepsis and following antibiotic stewardship

Methodology: A quality improvement methodology of process mapping and fishbone analysis was used to study workforce pathways and system tools to identify barriers. Four Plan-Do-Study-Act (PDSA) cycles were run in two six monthly blocks between 02/2017 to 07/2017 and 08/2018 to 01/2019.

Results: The outcome improved the average time of antibiotic administration from 120 minutes to 90 minutes

Early reporting of blood culture results of neonates from postnatal ward which helped in early discharge from the ward when cultures were negative

Improved awareness among staff about the importance of completing sepsis screen within 1hour

Changes implemented to bring about early delivery of blood culture bottles to the lab.

Conclusion: A Plan-Do-Check-Act quality improvement initiative for service innovation was used to improve care pathway for babies with risk factors or concerns regarding neonatal sepsis.

Value stream mapping helped to identify barriers and potential key areas for improvement.

Key feature for the success of the Neo-train Quality Improvement initiative was its use of a multidisciplinary team approach to strategically design and deliver the implementation program