G194(P) Variations in implementation of nice guideline: antibiotics for early-onset neonatal infection

Abstract

Background Variations between neonatal units in implementation of the Early Onset Neonatal Sepsis (EONS) National Institute for Health and Care Excellence (NICE) guideline CG149 were observed by trainees moving between units. Aim To explore variations in implementation of the NICE EONS guideline within the region, and identify quality improvement steps to improve implementation within shared network guidelines. Method Multicentre audit of compliance with the EONS NICE guideline was undertaken involving eight neonatal units within the two neonatal networks in the region. All neonates (≥34 weeks gestation), suspected of having EONS were prospectively audited over a consecutive four-week period between October 2016 – January 2017. Anonymised patient data was recorded on a standardised proforma. Results 320 neonates had suspected EONS. 53% were male with a mean ±SD gestation of 38.4±2.1 weeks. 93 (29%) did not fulfil criteria for initiation of antibiotics. 313 (98%) received Benzylpenicillin and 310 (97%) Gentamicin. 305 (95%) had a second C-reactive protein (CRP) level, but only 203 (67%) taken at 18–24 hours. 203/303 (67%) received first antibiotic dose within 1 hour from decision to treat, this varied between units from 25.8% to 91.7%. Blood culture result was unavailable in 98 (30%) by the NICE 36 hour target, this varied from 0% to 96.8% being available at 36 hours. There was one significant positive blood culture for Group B Streptococcus. Conclusions NICE EONS guideline is variably implemented. The units which performed better, have various toolkits, these include; use of an EONS proforma or electronic form within Badger.net, use of a drug chart with specific boxes for time of decision to treat, first dose of antibiotics administered and if greater than one hour then why, improved collaboration with microbiology laboratories to facilitate timely reporting of blood culture results and additional training on EONS. By implementing these changes then re-auditing we hope to see enhanced adherence to the EONS NICE guideline.