(143) Maternal Sepsis And Timely Antibiotic Administration: A Quality Improvement Initiative

Objective:
Maternal sepsis remains a major cause of pregnancy-related morbidity and mortality, with timely diagnosis and evidence-based treatment critical for improved outcomes. The California Maternal Quality Care Collaborative (CMQCC) has developed a validated maternal sepsis screen. Following a positive screen, antibiotic administration within one hour is recommended, even while awaiting confirmatory evaluation. This quality improvement (QI) initiative assessed baseline adherence to the one-hour antibiotic goal and identified system-level gaps, with a target of 80% compliance.

Study Design:
We conducted a retrospective chart review of pregnant and postpartum patients who screened positive for maternal sepsis with suspected infection at an academic medical center.  The primary measure was the proportion of patients receiving antibiotics within one hour of screening positive. Outcome measures included ICU admission and confirmed sepsis cases.  QI tools, including a Pareto chart and a key driver diagram, were used to assess root causes and guide future interventions.

Results:
Among 84 patients who screened positive, 56 (66%) patients had suspected infections and received antibiotics.  Of those treated with antibiotics, only 32 (57%) received them within the recommended one-hour timeframe.  Compliance fluctuated between 33-86% during the study period, with an initial decline followed by improvement after an education intervention in 7/2024 (Figure 1).  Adjusting for five cases in which providers waited for a second fever to diagnose intraamniotic infection, the adjusted one-hour compliance rate was 52%.  Only 32% of patients with confirmed sepsis and 28% of those requiring ICU admission received antibiotics within one hour.  Figure 2 demonstrates the causes of delays.

Conclusion:
Our findings highlight suboptimal adherence to the one-hour antibiotic target, with only 57% compliance overall and low compliance in patients with confirmed sepsis or ICU admission.  Provider education alone was insufficient; future efforts will target systemic interventions and support to improve timely antibiotic delivery for maternal sepsis.