6645 Barriers to timely administration of antibiotics for suspected early onset neonatal sepsis

Objectives To understand the barriers to administration of antibiotics for suspected early onset neonatal sepsis within an hour of the decision to treat. Methods Level 1 local neonatal unit with ∼300 admissions per year; Hospital with ∼2500 live births/year. In 2023, an Improvement Academy 'ABC for Patient Safety Toolkit'¹ was used to interview 13 nurses, nine senior house officers, nine registrars, and four consultants. Responders were asked their opinion on 28 statements on a Likert scale (from 'Strongly agree' to 'Strongly disagree'). Responses were analysed. From 2019 to 2023 five audits of antibiotic administration were conducted involving, on average 38 patients. A pharmacy monograph for intramuscular cefotaxime was introduced in 2021, along with unit posters and staff memos on the importance of timely administration of antibiotics. Results The mean time to antibiotic administration decreased from ∼95min (SD∼50min) to ∼65min (SD∼50min) upon the introduction of a pharmacy monograph for intramuscular cefotaxime on the unit, but failed to improve further despite information campaign including a poster and memos to the staff (figure 1). The analysis of the toolkit's questionnaire responses revealed that the lack of (1) personal responsibility (mean score 3.34), (2) example by senior staff (mean score 2.53), (3) habit (mean score 2.53), were the three highest scoring perceived barriers to the timely administration of antibiotics. Amongst other factors, neither lack of equipment or time, nor staff training or shortage were perceived as significant barriers (scoring 0.81, 1.16, 1.48, and 1.63, respectively). Conclusion The findings indicate that future interventions should address the perceived lack of personal responsibility, to promote good example by senior staff, and to help form a habit of assigning importance to the timely administration of antibiotics. The findings are interesting because they suggest the shift in emphasis from policies and equipment, to human factors, especially organisational ergonomics. Reference https://improvementacademy.org/resource/abc-for-patient-safety-toolkit/(last accessed 30/10/23).