Aim The primary aim was to audit the impact on omitted doses following the implementation of a new procedure which allow midwives to administer intravenous (IV) cefotaxime to neonates on postnatal wards. A secondary aim was to determine if cefotaxime was being prescribed in accordance with guidelines, and predominantly administered using pre-filled syringes provided by the centralised intravenous additive service (CIVAS).
Method The audit was a retrospective review of 43 neonates who received IV cefotaxime, over a 6-month period. Two audit tools were created in order to meet the set objectives; one to assess prescribing and the other to assess the ordering, supply and destruction of pre-filled syringes. Documentation assessed included patient notes, maternal notes, neonatal drug charts and peripheral cannula insertion/care records and 130 CIVAS record sheets. Data was analysed using Microsoft Excel and descriptive statistics.
Results There were no missed doses recorded, however in 21% of the charts audited there was documentation of one dose administered two hours later than the scheduled time, thus classified as delayed doses according to trust policy and NPSA guidance. 93% of neonates had cefotaxime correctly prescribed by weight and 81% received twice daily dosing at 09:00 and 19:00 as per guidance. Sodium chloride flushes had been omitted in 37% of charts and 12% of neonates who received a treatment beyond 48 hours did not have a medical review documented for continued treatment. In 28 out of 43 prescriptions (65%) audited, less than 50% of doses were administered using CIVAS syringes. Whereas, only 6 (14%) prescriptions, had 80% or more of the doses administered using CIVAS syringes as oppose to dry powder vials.
Conclusion There were no missed doses of cefotaxime identified showing there has been an improvement over previous practice where many missed doses were being reported using the incident reporting system. The audit highlighted poor record keeping of CIVAS syringes, which is essential for the service to be continued under section 10 exemption of the Medicines Act. As a result, record sheets have been redesigned and midwives appointed the responsibility of destroying unused or expired syringes on ward and completing record sheets. The launch of electronic prescribing over the next 6–8 months may ensure that the appropriate cefotaxime treatment regimen is prescribed. Furthermore, the system could incorporate a prescribable medical review that appears on charting; preventing the review being overlooked by staff. Finally, a re-audit is planned within the next 6 months to determine if there has been an improvement in adherence to the guidelines.
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