Table 1.

PDSA Cycles

	PDSA Cycle	Description
Feb 2015	VON Audit	Our team discussed the survey results and designated the PDSA cycles to achieve our aim.
Apr 2015	Update EOS and LOS guidelines, followed by the creation of standardized orders in the EMR	On admission, newborns at risk for EOS were to receive two doses of ampicillin (50 mg/kg IV q 12 h) and one dose of gentamicin. If the blood culture was negative and the infant’s clinical condition had improved, providers did not need to prescribe further doses of antibiotics.For LOS, the initial antibiotic treatment included nafcillin and gentamicin. Attending physicians decided the duration of antibiotic therapy.EOS and LOS guidelines did not include the determination of CRP or other inflammatory markers to aid in diagnosing sepsis or prolonging the duration of antibiotic treatment.
May 2015	Antibiotic “Time-Out”	During daily rounds, pharmacists questioned continued antibiotic usage in the presence of a negative blood culture. Providers documented in the EMR the reasons for continuing antibiotic treatment in newborns with a negative blood culture.
Jun 2015–Dec 2019	AUR Display in the NICU	We displayed run charts and SPCC in the NICU Quality Board and the unit’s electronic newsletter.
Aug 2017	Parents’ participation in rounds	Parents began participating in daily rounds as part of the Integrated Family Care initiative.
Dec 2017	Defer CBC after 4th hour of life	The team modified the admission order set to obtain a CBC after completing the 4th hour of life.

PDSA, plan do study act; VON, Vermont-Oxford Network; CRP, c-reactive protein; SPCC, statistical process control chart.