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Clinician adherence to guideline for phototherapy use in newborns
1Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN 55407, USA. madlo001@tc.umn.edu
Insights
Clinician adherence to newborn phototherapy guidelines was infrequent, with most infants receiving treatment in the optional range. A phototherapy nomogram did not improve adherence, suggesting a need for alternative interventions.
Area of Science:
- Neonatal Medicine
- Pediatric Guidelines
- Evidence-Based Practice
Background:
- The 2004 American Academy of Pediatrics guideline provides recommendations for phototherapy use in newborns.
- Variability in adherence to clinical guidelines can impact patient care and outcomes.
Purpose of the Study:
- To assess clinician adherence to phototherapy guidelines in newborns.
- To compare adherence rates between two hospitals.
- To evaluate the impact of a phototherapy nomogram on guideline adherence.
Main Methods:
- Retrospective review of medical records for 1160 newborns.
- Analysis of phototherapy administration and indication in 436 infants.
Main Results:
- Phototherapy was indicated in 37% of cases, not indicated in 8%, and subthreshold in 56%.
- Adherence varied significantly between the two hospitals.
- The phototherapy nomogram did not improve guideline adherence.
Conclusions:
- Clinicians rarely missed indicated phototherapy, but most infants received it in the optional range.
- Interhospital variability in adherence was observed.
- Alternative interventions are needed to improve phototherapy guideline adherence.
Objectives:
The objectives of this study were (1) to determine clinician adherence to the 2004 American Academy of Pediatrics guideline for phototherapy use in newborns; (2) to compare adherence to the guideline in 2 different hospitals; and (3) to determine whether adherence to the guideline improved after the phototherapy nomogram was available in newborn charts.
Methods:
This study was a retrospective review of medical records of 1160 newborns receiving care at the normal newborn nurseries at 2 Twin City, MN, hospitals. Four hundred thirty-six infants received phototherapy.
Results:
When phototherapy was administered, it was indicated in 37% of cases and not indicated in 8%. In 56% of cases it was considered subthreshold. When phototherapy was not administered, it was appropriate in 99% of cases but was inappropriate or missed in 1% of cases. There was a significant difference in clinician adherence to the phototherapy guidelines between the hospitals. The addition of the phototherapy nomogram to the newborn charts did not change adherence to the guideline.
Conclusions:
Clinicians infrequently missed providing phototherapy when it was indicated. Most infants received phototherapy when their bilirubin level was in the "optional" range. The interhospital variability of guideline adherence confirms results found in other studies. Because the addition of the phototherapy nomogram alone did not improve adherence to the guideline, alternative interventions targeted at nurseries should be considered.
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