6288 Sepsis ‘golden hour’: quality improvement initiative to improve neonatal antibiotic stewardship practices. University hospital of coventry and warwickshire

Objectives Early onset sepsis is one of the leading causes of morbidity, and mortality among neonates. For neonatal infections (early-onset, within 72 hours of birth, or late-onset, more than 72 hours of birth), prompt initiation of antibiotics can prevent life-threatening neonatal sepsis.¹ A 'golden hour' approach is recommended, ensuring antibiotics are given within 60 minutes of the decision to treat. However, misuse of antibiotics can be detrimental. Antibiotic stewardship optimises the use of antibiotics, minimising drug toxicity and adverse effects, preventing the emergence of multi-drug resistant strains and improving the cost-effective use of health care resources.² Objectives To ensure neonates with signs/symptoms of infection requiring treatment are administered antibiotics within 60 minutes of the decision to treat To adopt practices for management and prevention of neonatal sepsis, intramuscular antibiotics, and KPSRC. Methods A multi-professional team was formed across the neonatal and maternity services. QI methodology was used to identify barriers, including process mapping, fishbone analysis and driver diagram. Implementation of changes using LEAN methodology and quarterly Plan-Do-Study-Act (PDSA) cycles. CYCLE 1 Introduction of education update and sepsis trolley. CYCLE 2 Changes to speed up hospital number generation and baby labelling. CYCLE 3 KPSRC for well-appearing babies with risk factors, safely reducing antibiotic prescribing. CYCLE 4 A stat dose of intramuscular administration of Cefotaxime when cannulation is difficult. Results 1,729 babies (admitted into neonatal and post-natal unit) screened for infection over 29 months. The median percentage of babies receiving antibiotics within the golden hour (60 minutes of the decision to treat) improved remarkably from 64% (Q4; Oct – Dec 2020) to 100% (Q1; Jan – Mar 2023). The number of infection screens reduced from a peak of 35 screens (Median; Q1; Jan – Mar 2021) to 21 (Median; Q1; Jan – Mar 2023), with an apparent decrease in the number of babies screened on the post-natal ward. Conclusion Sustainable changes were made from targeted interventions, a sequel from detailed data analysis and identifying barriers using QI methodology. Neonates requiring treatment for neonatal sepsis now receive antibiotics within 60 minutes of the decision to treat. KPSRC has safely reduced the number of neonates with infection risk factors requiring empirical antibiotic treatment. References Neonatal infection: Antibiotics for prevention and treatment: Guidance. NICE 2021. Core elements of human antibiotic stewardship programs in resource-limited settings. Centres for Disease Control and Prevention 2023.