Implementing the Early Onset Sepsis Calculator in a Neonatal Intensive Care Unit

Abstract

Problem& Purpose: While intrapartum antibiotics have decreased the incidence of early onset sepsis (EOS) in infants > 34 weeks, there has not been an equal decrease in how often antibiotics are administered to treat suspected EOS. The use of an EOS calculator to help guide management has been shown to safely decrease the use of antibiotics. In this 52-bed neonatal intensive care unit (NICU), providers did not use an EOS calculator and the interpretation of the recommendations across providers greatly varied. There is no standard algorithm to stratify at risk infants for EOS in order to differentiate infants requiring antibiotics from those who can be safely observed. The purpose of this quality improvement project is to implement and evaluate the effectiveness of the early onset sepsis calculator in a level IV NICU for infants > 34 weeks gestational age on reducing antibiotics usage. Methods: Over a 15-week period in the fall of 2021, a multidisciplinary team implemented the EOS calculator to be utilized in the electronic health record (EHR). Data collection occurred through chart review of any infant > 34 weeks gestation that was admitted to the NICU. Data that was collected included gestational age, calculator use and recommendations, antibiotic administration, was a CBC and a blood culture obtained, and was there adherence to the calculator recommendations. Results: Post implementation 10% (n=110) of infants admitted to the NICU that were eligible for use of the EOS calculator had documentation of use within the EHR. The goal remains that 100% of infants > 34 weeks will have recommendations documented on the EOS calculator. Approximately, 50% of infants received antibiotics on admission. Conclusions: The education disseminated on the location and use of the EOS calculator has led more providers to utilize the calculator than prior to the implementation. The use of the EOS calculator has created better communication amongst providers about how to manage infants at risk for EOS.