To reduce the average time taken from antibiotic prescription to administration on CHH Ward 1 to under 60 minutes (monthly average time taken) by 31st August 2023.
SHO doctors covering C1 noted anecdotally that there was a significant period between prescribing antibiotics and having them administered. Data has shown on average 68 minutes pass before administration, taking response time beyond the ‘golden hour’ associated with improved outcomes in sepsis treatment. This directly impacts patient health and also affects staff morale, as doctors and nurses reported some frustration at length of time.
We reviewed the average time taken between prescription and administration of antibiotics on C1 as recorded on Lorenzo. 95% confidence intervals for the average time were calculated and recorded.
Our initial idea was to create a poster in C1 reminding doctors to let nurses know once prescriptions had been completed so they could order the antibiotic and/or administer immediately. We also considered reminding doctors to check IV access (identified as a cause of delay by nurses). These areas were identified through discussions with nursing and medical staff who work on C1, by talking with them on 3 separate occasions on the ward.
Our project will be successful when we record a month of data, calculate the average time taken and find it has been reduced to under 60 minutes.
Active listening: during meetings with nurses, in order to generate interest in our project. Also in team meetings to help provide feedback and a positive environment to create ideas for our project’s intervention.
Brainstorming: during team meetings initially to decide where to perform our project, then deciding on a possible intervention. Also following feedback from sepsis nurses and C1 staff, we were able to amend our intervention through discussing possible changes and implementing them.
Driver diagrams: we created a driver diagram during a QIP team meeting to break down the problem we had identified (ABx administration waiting time) into primary and secondary drivers, which then allowed us to generate ideas for change.
SMART aims: once we had identified the area we wanted to improve, we were able to brainstorm a series of specific ideas for our SMART aim, deciding on “To reduce average time taken from antibiotic prescription to administration on CHH Ward 1 to under 60 minutes (monthly average time taken) by 31st August 2023”.
Stakeholder analysis: multiple meetings with nurses, auxiliaries, SHOs and registrars who work on C1.
We have created a visually appealing poster which will be placed in key areas around the ward to remind doctors to engage with their nursing colleagues and ensure IV access is available (if required). We have also included a QR code to relevant guidelines for staff to scan if unsure about doses etc.
We will be able to directly compare time taken before and after our intervention. The findings will then be fed back to sepsis nurses and C1 nursing staff, to provide encouragement. The intervention aims to increase communication between nurses and doctors, and this will hopefully continue to develop.
We are currently finishing our second draft of the poster-based intervention. Once this is completed, we intend to place it in the treatment room and doctor’s room for maximum impact. Our intentions are to either add on another intervention at C1 that we had brainstormed earlier in the process (targeting IV access), or to apply a similar poster-based intervention on H6/60. As a group we have learned that engaging with stakeholders can be very challenging; sometimes nurses we talked to adamantly denied that there was any issue with delayed administration of antibiotics, but when we discussed the quantitative findings (68 minutes on average delayed), and framed it as ‘what can we as doctors do to improve/make tasks easier for you’, we found they were more engaging.