Decreasing Antibiotic Turnaround Time in the Medical Intensive Care Unit: A Quality Improvement Project

Purpose: This QI project aimed to increase the percentage of first-dose antibiotics administered within one hour of order placement to 80% in the ICU by 12/31/24. Background: Antibiotic Turnaround Time (ATT) is the time between antibiotic order placement and administration. Prolonged ATT can cause adverse outcomes by delaying treatment. In 2023, only 54% of first-dose antibiotics were given within the EBP standard of one-hour in our 36-bed Medical ICU. Methodology: The Six Sigma DMAIC model identified barriers and interventions to achieving target ATT using stakeholder input, process mapping, and root cause analysis. Multidisciplinary Plan-Do-Study-Act (PDSA) cycles were created to evaluate their effectiveness. We focused on one core discipline, nursing staff. Interventions included education aimed at correcting nursing ATT misconceptions through huddles and informational flyers. ATT data was collected and measured weekly for 10 weeks using Tableau. Results: Post-initiation of nursing education, the weekly percentage of antibiotics administered within one hour fluctuated, ranging from 36.36% to 79.17%, with a mean of 61.86% for the cycle. Barriers to meeting goal ATT were found to be the same as those identified in the RCA including delays in antibiotic delivery and lack of intravenous access. An ATT Committee was formed to standardize changes across ICUs and continue further PDSA cycles. Implications: The findings suggest that while addressing nursing-related barriers can reduce ATT delays, an interdisciplinary approach is necessary for sustainable, meaningful improvement. PDSA cycles can now be initiated to address non-nursing barriers in pharmacy/delivery and the EHR.