scholarly journals P28 Gentamicin-related incidents in neonates before and after the introduction of electronic prescribing and medicines administration (ePMA)

2020 ◽  
Vol 105 (9) ◽  
pp. e20.2-e21
Author(s):  
Kimberly Mak
Keyword(s):  
Early Onset ◽  
Reporting System ◽  
Neonatal Infection ◽  
Electronic Prescribing ◽  
List Type ◽  
Electronic Prescription ◽  
Blood Samples ◽  
Incident Reporting System ◽  
Early Onset Sepsis ◽  
Before And After

AimGentamicin is widely used to treat early neonatal sepsis as part of a regimen recommended by NICE.1 However, it is frequently implicated in clinical incidents relating to errors in prescribing and administration. This project aimed to evaluate whether the introduction of ePMA had an effect on the frequency and type of incidents that occur relating to the use of gentamicin in neonates.MethodA paper gentamicin prescription chart was used from July 2013 until the implementation of ePMA on 28th January 2019. Using ePMA, prescribers were encouraged to use a pre-set template for ‘neonatal early onset sepsis’, listing benzylpenicillin and gentamicin (in mg/kg). Prescribers had to input the date and time of the first dose, and the system would automatically calculate the dose and time of subsequent administrations. A visual cue was used by the system to signal to nurses that a dose was due. Data was extracted from our local incident reporting system between the periods of 1st July 2013 to 27th January 2019 (‘pre-ePMA’) and 28th January 2019 to 30th June 2019 (‘post-ePMA’), where ‘gentamicin’ was mentioned in the incident description under the ‘neonates’ specialty. The data was examined, categorised into ‘prescribing-related’, ‘administration-related’, or ‘other’ and within the former two, grouped into identified themes.ResultsPre-ePMA 55 incidents were reported (mean=9/year, range 6–16/year), of which 41 (75%) were deemed to have the potential to cause harm. 27 (49%) incidents were prescribing-related and 19 (35%) were administration-related. The rest of the incidents were classed as ‘other’ eg. mislabelling blood samples. The most common prescribing-related incidents were incorrect frequency intervals, accidental omission, incorrect dose, or failing to meet prescribing standards. The most common administration-related incidents were doses being given too early, too late or missed. Four incidents were reported in the 5-month period post-ePMA (2 prescribing-related, 1 administration-related, 1 other). All prescribing- and administration-related incidents were deemed to have the potential to cause harm. One incident was due to incorrect frequency (first dose was given before arrival and prescriber had to manually calculate interval), one incident related to unintended doses prescribed and given (only benzylpenicillin was indicated), and one administration incident from poor documentation (dose given but not signed for). Compared with the same 5-month period in 2018 (pre-EPMA), 1 more incident had been reported this year compared to the previous year where only 3 incidents were reported.ConclusionThe introduction of ePMA may not reduce the number of reported incidents relating to gentamicin in neonates. A longer period of study is needed to evaluate the effects of transitioning from paper to ePMA. Our results suggest that ePMA can eliminate or reduce the risk of some types of errors, but can also make no difference to others, and can create new types of system-related errors, which can still have the potential to cause harm. This is consistent with the outcomes of a similar study in 2016 in another centre.2ReferencesNational Institute for Health and Care Excellence (NICE). Neonatal infection (early onset): antibiotics for prevention and treatment. Manchester: NICE; 2012.Kitson G. Implementation of an electronic prescription chart for gentamicin for neonatal units and postnatal wards. Arch Dis Child, 2016;101e2.

scholarly journals P037 Evaluating the introduction of dose banded cefotaxime using pre- filled syringes, for early onset sepsis on a neonatal unit

2019 ◽  
Vol 104 (7) ◽  
pp. e2.42-e2
Author(s):  
Suzannah Hibberd
Keyword(s):  
Early Onset ◽  
Electronic Prescribing ◽  
Drug Preparation ◽  
List Type ◽  
Nice Guideline ◽  
Batch Number ◽  
Early Onset Sepsis ◽  
Mandatory Requirement ◽  
Group A ◽  
Group B

BackgroundIn December 2017, cefotaxime doses for treatment of early onset sepsis were banded according to weight. The dose-banding only applies to neonates <7 days old. The implementation of pre-filled syringes (PFS) supplied by the Pharmacy Technical Services Unit coincided with the introduction of cefotaxime dose-banding.AimTo assess whether cefotaxime is prescribed according to the dose-banding guideline. To establish if batch numbers of PFS are reconciled on the electronic prescribing system (EPS). To determine whether introducing PFS has resulted in more neonates receiving the first dose of antibiotics within 1 hour of the decision to treat.MethodsAn EPS report was generated for 2 groups of patients. Group A received cefotaxime from April to June 2018, group B received cefotaxime from September to November 2017, before dose-banding was introduced. Data collected included: weight; dose; time of prescribing and time of administration for the first dose; whether a PFS was used and if the batch number was reconciled electronically. Patients transferred into the unit were excluded as they had started their antibiotics prior to transfer.Results95.3% of group A, (n=85), received doses in accordance with the guideline, two doses were prescribed according to weight. Out of the 95.3% eligible to receive PFS, 91.4% of PFS were documented on the EPS. It was unknown whether PFS were used for the remaining patients. 90.5% of the PFS batch numbers were reconciled, 8.1% were not reconciled and 1.4% had incomplete records. 81.2% of group A received the first dose of antibiotics ≤60 minutes from the point of prescribing in comparison to 76.6% in group B (n=94). 58.8% of group A and 42.6% of group B had doses administered ≤30 minutes after prescribing. Both groups had 5 patients that did not receive their first dose until >2 hours after prescribing.ConclusionThe majority of prescribers are using the dose- banding guideline. 91.4% of doses have been administered using PFS, thereby reducing nursing time used for IV drug preparation. In 8.6% it could not be determined whether a PFS was used although prescription templates had been used. The template includes a mandatory box to say if a PFS has been used, nurses cannot sign the drug administration if it is empty. An outcome from this study is that this discrepancy will be investigated by the electronic prescribing team. Nurses are recording batch numbers onto the EPS in 90.5% of cases. Nurses will be reminded to reconcile batch numbers and making it a mandatory requirement on the EPS will be investigated Having PFS available has led to more patients receiving their dose within 30 minutes and slightly more receiving their doses within 60 minutes. However similar numbers are still receiving their doses >60 minutes after prescribing. Next steps will be to examine cases where antibiotics are delayed and identify causes. A limitation of this study is that it does not take into account how long it takes the prescriber to write the prescription after making the decision to treat.ReferenceNational Institute for Health and Clinical Excellence. ( 2012) Neonatal Infection (early onset): antibiotics for prevention and treatment. NICE Guideline (CG149)

P26 An audit of the use of amikacin for early onset sepsis in premature neonates in an inpatient neonatal unit

2018 ◽  
Vol 103 (2) ◽  
pp. e1.31-e1
Author(s):  
Dalton Caroline ◽  
Benzaken Tami ◽  
Tyszczuk Lidia ◽  
Gozar Ioana
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Early Onset ◽  
Ductus Arteriosus ◽  
Neonatal Infection ◽  
Extremely Low Birth Weight ◽  
List Type ◽  
Premature Neonates ◽  
Early Onset Sepsis ◽  
Trough Levels

AimIn April 2017 the Trust updated the Neonatal Infection Guideline due to increasing resistance to gentamicin. Subsequently, the first line aminoglycoside to treat early onset sepsis (EOS) on neonatal units (NNU) for patients ≤32 weeks gestation changed from gentamicin to amikacin.Updated guidance recommends prescribing amikacin 15 mg/kg 24 hourly, aiming for trough levels<5 mg/L; however anecdotal reports suggest this results in frequently high trough levels at 24 hours.Adherence to current guidelines was audited, to gain insight into the most appropriate dosing interval to use, particularly in extremely low birth weight (<1 kg) and extremely premature neonates (<28 weeks gestation at birth).Audit aims100% of patients prescribed amikacin for EOS adhere to criteria in Neonatal Infection Guideline100% of patients prescribed amikacin dose of 15 mg/kg100% of patients prescribed amikacin have a blood level taken at 24 hours (prior to giving second dose)100% of patients receive further doses of amikacin only when blood levels are <5 mg/L, or under the advice of a pharmacistMethodAudit standards were derived from hospital policy. All eligible neonates receiving amikacin were included. Neonates on postnatal wards were excluded; they should receive gentamicin for treatment of EOS.Prospective data collection was completed across both NNUs at the Trust, which included all neonates that received doses of amikacin from 1st April to 1st August 2017. Data were collected from drug charts and medical records. Data were also collected to account for factors that could contribute to or highlight that the patient suffered from poor renal output; degree of prematurity (gestational age), urine output, urea and electrolytes, any inotropic support, or a significant patent ductus arteriosus. Data were entered onto an Excel spread sheet and were summarised descriptively. The audit was approved locally.ResultsA total of 50 neonates received amikacin. 100% adhered to criteria in Neonatal Infection Guideline and 100% prescribed doses of 15 mg/kg. 12 patients (24%) did not have an amikacin level taken at 24 hours, of which 5 (42%) had stopped antibiotics and 7 (58%) had levels taken between 27–36 hours. Of the remaining 38 patients, only 6 (16%) had levels<5 mg/L at 24 hours. Nine (24%) patients then stopped antibiotics at 36 hours. 23 patients had levels taken at 36 hours, of which 17 (74%) could be classed as ‘in range’ at ≤5 mg/L. Two patients received doses despite levels of >5 mg/L. Final results are yet to be fully analysed, however it appears as though there is no direct correlation between gestational age, severity of illness and amikacin level results.ConclusionFindings suggest it is difficult to pre-determine how a patient will excrete amikacin, even when taking into account gestational age and birth weight; which would support the literature.¹ However, the majority of levels were high at 24 hours and within range by 36 hours, so change in practice from 24 hourly to 36 hourly dosing is recommended. Following implementation of the recommendations, further audit is necessary in one year.ReferenceAllegaert K, Anderson BJ, Cossey V, et al. Limited predictability of amikacin clearance in extreme premature neonates at birth. British Journal of Clinical Pharmacology2005;61:39–48.

The Utility of Soluble CD14 Subtype in Early Diagnosis of Culture-Proven Early-Onset Neonatal Sepsis and Prediction of Outcome

2019 ◽  
Vol 37 (05) ◽  
pp. 497-502
Author(s):  
Ghada I. Gad ◽  
Dina M. Shinkar ◽  
Manal M. Kamel El-Din ◽  
Hoda M. Nagi
Keyword(s):  
Early Onset ◽  
Quantitative Measurement ◽  
Significant Decline ◽  
Sepsis Severity ◽  
Prediction Of Outcome ◽  
Soluble Cd14 ◽  
Blood Samples ◽  
Early Onset Sepsis ◽  
Sepsis Screening ◽  
Cluster Of Differentiation

Abstract Objective This study aimed to evaluate soluble cluster of differentiation 14 subtype (sCD14-ST), also named presepsin, as an early marker for the diagnosis of culture-proven early-onset sepsis (EOS) in neonates and to assess its relation to disease severity and mortality. Study Design Out of 60 neonates with risk factors of EOS, 31 neonates were diagnosed as having culture-proven EOS. They were compared with 20 nonseptic controls. We obtained blood samples on day 1 of life for sCD14-ST measurement and sepsis screening. Blood samples were repeated on day 3 in EOS neonates. Results sCD14-ST was significantly higher in EOS neonates than controls (p < 0.001). Neonates who later developed septic shock had significantly higher day 1 sCD14-ST level than those who did not (p < 0.001). Furthermore, neonates who died had significantly higher day 1 sCD14-ST than survivors (p < 0.001). On day 3, there was a significant decline in sCD14-ST levels than initial levels among survivors. There was a significant positive correlation between day 1 sCD14-ST level and Tollner's sepsis severity score. Conclusion sCD14-ST could be used as a powerful diagnostic and prognostic marker of EOS. Its quantitative measurement at birth could be a good predictor of sepsis severity and mortality.

scholarly journals Neonatal Nasopharyngeal Bacterial Colonization: Prevalence, Antimicrobial Resistance, and Concomitant Early-onset Sepsis

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Masoud Dehdashtian ◽  
Mojtaba Moosavian ◽  
Meysamreza Boghrati ◽  
Maniya Arshadi ◽  
Arash Malakian ◽  
...  
Keyword(s):  
Blood Culture ◽  
Early Onset ◽  
Bacterial Colonization ◽  
Antibiotic Sensitivity ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Culture Bottle ◽  
Blood Samples ◽  
E Coli ◽  
Early Onset Sepsis

Background: Early-onset neonatal sepsis (ENOS) is one of the most common causes of mortality in neonates. The bacteria causing ENOS are generally transferred from the mother to the infant before or during labor. Objectives: This study aimed to determine the prevalence rate of nasopharyngeal colonization with common bacterial agents causing ENOS and their relationship with blood culture outcomes in neonates. Methods: All neonates transferred to the neonatal intensive care unit were included in the study. Posterior pharynx secretions were swabbed and cultured in blood agar and MacConkey agar. Also, a blood specimen from each neonate was inoculated into a blood culture bottle. The grown bacteria were identified by biochemical standard tests. The antibiotic sensitivity test was performed by the disk diffusion method using Mueller-Hinton agar, and the results were evaluated according to the CLSI guidelines. Results: The pharyngeal specimens collected from 114 newborns were positive in 83 (72.8%) cases. Staphylococcus epidermidis was the most common bacterium in all weight groups. However, the isolates of Klebsiella, Escherichia coli, S. aureus, and Streptococcus agalactiae were also high. Thirteen newborns died. Neonates’ pharyngeal specimens were positive among 11 (84.6%) cases who died and 101 (71.2%) neonates who survived. Twelve neonates had positive blood cultures. Simultaneous positive blood and pharyngeal cultures were reported in eight (7%) cases, in which the bacterial isolates from blood and pharyngeal samples were similar in three cases (37.5%). Among pharyngeal isolates, E. coli was resistant to ampicillin in 100% and gentamicin, cefotaxime, and ceftazidime in 50% of the cases. Also, S. epidermidis and Acinetobacter isolates from blood samples were resistant to ampicillin in 100% of the cases. Conclusions: S. epidermidis accounted for 38.6% of bacteria cultured from pharyngeal swabs and 66.7% of bacteria cultured from blood samples, 37.5% of which were resistant to ampicillin and 100% were sensitive to vancomycin. One-hundred percent of E. coli cultures from neonatal pharynges were resistant to ampicillin and about 50% of them were resistant to gentamicin, cefotaxime, and ceftriaxone.

Dietary Changes in Fasting Levels of Factor VII Coagulant Activity (FVII: C) Are Accompanied by Changes in Factor VII Protein and other Vitamin K-dependent Proteins

1995 ◽  
Vol 73 (02) ◽  
pp. 239-242 ◽  
Author(s):  
E M Bladbjerg ◽  
T Tholstrup ◽  
P Marckmann ◽  
B Sandström ◽  
J Jespersen
Keyword(s):  
Fatty Acids ◽  
Vitamin K ◽  
Protein C ◽  
Saturated Fatty Acids ◽  
Factor Vii ◽  
Dietary Regimen ◽  
Blood Samples ◽  
Dietary Changes ◽  
Coagulant Activity ◽  
Before And After

SummaryThe mechanisms behind dietary effects on fasting coagulant activity of factor VII (FVII: C) are not clarified. In the present study of 15 young volunteers, two experimental diets differing in composition of saturated fatty acids (C18:0 [diet S] or C12:0 + C14:0 [diet ML]) were served for 3 weeks each. Fasting blood samples were collected before and after the dietary regimen and analysed for triglycerides, FVII:C, and protein concentrations of FVII, FII, FX, protein C, CRP, albumin, fibrinogen, and F1+2. FVII:C was significantly reduced on diet S compared with diet ML. This was accompanied by a decrease in FVII protein, F1+2 and the vitamin K-dependent proteins FII, FX, and protein C. In contrast, no changes were observed in triglycerides, FVII:C/FVII: Ag, albumin and CRP. Fibrinogen was increased on diet S compared with diet ML. Our findings suggest that the change in fasting FVII:C was part of a general change in concentrations of vitamin K-dependent proteins.

NEONATAL SEPSIS AND IDENTIFICATION OF RISK FACTORS: STUDY IN AVBRH HOSPITAL SAWANGI

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pramod P. Singhavi
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Signs And Symptoms ◽  
Premature Rupture ◽  
Maternal Risk ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Meconium Stained Amniotic Fluid

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

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