TY - JOUR
T1 - Quality Improvement Through Nurse-initiated Kaiser Sepsis Calculator at a County Hospital
AU - Hadfield, Brandon R.
AU - Rowley, Justin
AU - Puyol, Franz
AU - Johnson, Meagan A.
AU - Ali, Murtaza
AU - Neuhoff, Barbara K.
AU - Lyman, Rachel
AU - Saravia, Alma
AU - Svatek, Mandy
AU - Sherburne, Kelsey
AU - Cantey, Joseph B.
N1 - Publisher Copyright:
© 2023 American Academy of Pediatrics. All rights reserved.
PY - 2023/1
Y1 - 2023/1
N2 - BACKGROUND AND OBJECTIVES: Suspected early onset sepsis drives most antibiotic use in the newborn nursery. The Kaiser Sepsis Calculator (KSC) is a validated tool that safely decreases laboratory evaluation and antibiotic administration in infants aged $34 weeks. Our quality improvement aim was a nurse-initiated, KSC-based program to decrease blood cultures (BCx) and complete blood counts (CBC) by 10% from March 2021 to October 2021 among chorioamnionitis-exposed infants born $35 weeks’ gestation. A secondary aim was to decrease antibiotic administration by 10%. METHODS: The KSC was implemented for infants at University Health, a county hospital affiliate of the University of Texas Health Science Center San Antonio, with a level I nursery and level IV NICU. The multidisciplinary project included pediatric hospitalists, neonatologists, family practitioners, maternal–fetal medicine physicians, fellows, residents, and nurses. All infants born 6 months before (August 2020–January 2021) and 7 months after protocol implementation (March 2021–September 2021) were analyzed. RESULTS: A total of 53 chorioamnionitis-exposed infants were included from the preintervention period and 51 from the postintervention period. CBC utilization decreased from 96% to 27%, BCx utilization decreased from 98% to 37%, and antibiotic utilization fell from 25% to 16%. In no cases were antibiotics prescribed against the KSC, and to our knowledge, no early onset sepsis diagnoses or infection-related hospital readmissions were missed. CONCLUSIONS: The multidisciplinary implementation of the KSC led to a reduction in testing, exceeding our initial goal. A nurse-initiated protocol reduced BCx, CBC, and antibiotic utilization among chorioamnionitis-exposed infants.
AB - BACKGROUND AND OBJECTIVES: Suspected early onset sepsis drives most antibiotic use in the newborn nursery. The Kaiser Sepsis Calculator (KSC) is a validated tool that safely decreases laboratory evaluation and antibiotic administration in infants aged $34 weeks. Our quality improvement aim was a nurse-initiated, KSC-based program to decrease blood cultures (BCx) and complete blood counts (CBC) by 10% from March 2021 to October 2021 among chorioamnionitis-exposed infants born $35 weeks’ gestation. A secondary aim was to decrease antibiotic administration by 10%. METHODS: The KSC was implemented for infants at University Health, a county hospital affiliate of the University of Texas Health Science Center San Antonio, with a level I nursery and level IV NICU. The multidisciplinary project included pediatric hospitalists, neonatologists, family practitioners, maternal–fetal medicine physicians, fellows, residents, and nurses. All infants born 6 months before (August 2020–January 2021) and 7 months after protocol implementation (March 2021–September 2021) were analyzed. RESULTS: A total of 53 chorioamnionitis-exposed infants were included from the preintervention period and 51 from the postintervention period. CBC utilization decreased from 96% to 27%, BCx utilization decreased from 98% to 37%, and antibiotic utilization fell from 25% to 16%. In no cases were antibiotics prescribed against the KSC, and to our knowledge, no early onset sepsis diagnoses or infection-related hospital readmissions were missed. CONCLUSIONS: The multidisciplinary implementation of the KSC led to a reduction in testing, exceeding our initial goal. A nurse-initiated protocol reduced BCx, CBC, and antibiotic utilization among chorioamnionitis-exposed infants.
UR - http://www.scopus.com/inward/record.url?scp=85150054810&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150054810&partnerID=8YFLogxK
U2 - 10.1542/hpeds.2022-006554
DO - 10.1542/hpeds.2022-006554
M3 - Article
C2 - 36537146
AN - SCOPUS:85150054810
SN - 2154-1663
VL - 13
SP - 31
EP - 38
JO - Hospital pediatrics
JF - Hospital pediatrics
IS - 1
ER -