{
  "abstract": "Context, Situation or Problem Hospital-at-home services are increasingly used to deliver safe and effective acute care to children in the community. 1 This model helps reduce hospital stays, improve patient flow, and support family-centred care. Within this service, ceftriaxone is a frequently used intravenous antibiotic. However, a review across four acute NHS trusts delivering this care revealed significant variation in prescribing, preparation, and administration practices. Differences in reconstitution methods, dilution volumes, and routes of administration created operational inefficiencies and posed potential safety risks.To address this, a multidisciplinary short-life working group was formed. It included pharmacists, paediatricians, and senior nursing staff from all participating organisations. The group conducted a comprehensive review of existing local practices, national guidance, relevant literature, and collective clinical experience to inform the development of a standardised ceftriaxone guideline.Key components of the new guideline included the adoption of unified dose banding, standardised preparation and dilution methods, and clear administration protocols. A major change was the introduction of a 10-minute intravenous infusion time for all non-neonatal paediatric patients for doses of 80 mg/kg. This adjustment was supported by available evidence and aimed to improve the practicality of delivering antibiotics at home. The guideline also included recommendations on suitable volumes for intramuscular administration in situations where intravenous access was not feasible, recognising the limited evidence base for this. Additional practical advice was provided to help clinicians safely advance doses when needed to avoid disruption in home-based treatment.Following staff training, stakeholder engagement, and clinical governance approval, the guideline was implemented across all four sites. We are now working with community nursing teams to support adoption of the guidance in their services. Other hospital-at-home services have also expressed interest in adapting the guidance for use in their own settings.Conclusion or Lessons Learned The introduction of a standardised ceftriaxone guideline has improved the quality, safety, and efficiency of care provided to children receiving intravenous antibiotics at home. Clear, consistent guidance has reduced local variation and supported safer, more confident prescribing and administration practices. The shortened infusion time has facilitated smoother patient flow and enhanced the feasibility of delivering care in the home environment. Feedback from clinical staff has been positive, with the clarity and usability of the guideline frequently highlighted.No adverse incidents or safety concerns related to the new guideline have been reported since implementation. While intramuscular administration is used sparingly due to limited supporting evidence, having an agreed approach has improved confidence and flexibility in managing complex cases.This work demonstrates the value of collaborative, cross-organisational quality improvement. Pharmacy leadership played a key role in driving this initiative, highlighting the profession’s impact on safe and effective medicines use beyond the hospital. The guideline also supports antimicrobial stewardship and provides a replicable model for standardising other high-use medicines across regional or integrated care pathways.Reference NHS England. Virtual wards operational framework [Internet]. 2024 [cited May 2025]. Available from: https://www.england.nhs.uk/long-read/virtual-wards-operational-framework/.",
  "authors": [
    {
      "affiliations": [
        "Imperial College Healthcare NHS Trust, UK",
        "Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, UK"
      ],
      "name": "Ashifa Trivedi"
    },
    {
      "affiliations": [
        "Imperial College Healthcare NHS Trust, UK"
      ],
      "name": "Penny Fletcher"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, UK"
      ],
      "name": "Courtney Preston"
    },
    {
      "affiliations": [
        "London North West University Healthcare NHS Trust UK"
      ],
      "name": "Aquila Rajwani"
    },
    {
      "affiliations": [
        "The Hillingdon Hospitals NHS Foundation Trust, UK"
      ],
      "name": "Svitlana Beard"
    }
  ],
  "title": "P01 Standardising ceftriaxone use for children in a hospital-at-home service",
  "uid": "a6012765-0cff-53ca-9700-214aaf397c05"
}