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Effect of revised nursery orders on newborn preventive services
1Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA. madlo001@tc.umn.edu
Insights
Implementing updated nursery orders significantly improved hepatitis B virus (HBV) immunization rates and group B streptococcus (GBS) care for newborns. Discharge follow-up plans showed no significant change. This highlights the impact of standardized protocols on neonatal quality of care.
Area of Science:
- Neonatal medicine
- Public health
- Pediatrics
Background:
- Evolving guidelines in neonatal care address hepatitis B virus (HBV) immunization, discharge follow-up, and perinatal group B streptococcal (GBS) disease prevention.
- A university hospital revised its standardized newborn nursery orders in 2007 to align with current recommendations in these critical areas.
Purpose of the Study:
- To evaluate the impact of newly implemented standardized nursery orders on the quality of neonatal care.
- To assess changes in HBV immunization rates, GBS prophylaxis, and discharge follow-up adherence post-order revision.
Main Methods:
- Retrospective review of 857 infant medical records, birth certificates, and a computer database.
- Analysis of changes in nursery orders including opt-out HBV immunization, American Academy of Pediatrics (AAP)-based discharge follow-up, and modified GBS protocols.
Main Results:
- A significant increase in HBV immunization rates from 74% to 83% (P = .0018).
- A substantial rise in complete blood counts for newborns whose mothers received GBS antibiotics within 4 hours of delivery, from 36% to 83% (P < .0001).
- No significant change observed in the adherence to AAP-recommended discharge follow-up plans.
Conclusions:
- A straightforward modification to nursery orders led to demonstrable improvements in specific aspects of newborn care.
- The study underscores the effectiveness of standardized protocols in enhancing neonatal care quality, particularly for immunization and GBS prevention.
Objective:
Aspects of neonatal care that are the subject of evolving guidelines include hepatitis B virus (HBV) immunization; discharge follow-up recommendations; and prevention of perinatal group B streptococcal (GBS) disease. In 2007, a university hospital's standardized newborn nursery orders were changed to reflect current recommendations in these areas. The objective of the study was to determine the effect of new nursery orders on the quality of care provided to these newborns.
Methods:
The study was a retrospective review of medical records, birth certificates, and a computer database of 857 infants. The nursery orders changed in the following ways: (1) physicians had to "opt out" of HBV immunization; (2) discharge follow-up recommendations were based on American Academy of Pediatrics (AAP) recommendations; and (3) AAP recommendations for GBS were followed except blood cultures were not required for certain infants.
Results:
The percentage of infants receiving HBV immunizations increased from 74% in 2007 to 83% in 2008 (P = .0018). The percentage of infants whose mothers received antibiotics for GBS less than 4 hours before delivery and who received a complete blood count increased from 36% to 83% (P < .0001). The percentage of newborns who had discharge follow-up plans consistent with AAP recommendations did not change significantly.
Conclusion:
A simple change in nursery orders was associated with significant improvement in newborn care.
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