Maternal Group B Streptococcus Prophylaxis Improvement using an Electronic Medical Record Dynamic Order Set.

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Health Informatics

Background:

• Group B Streptococcus (GBS) prophylaxis is crucial for preventing early-onset GBS disease.
• Adherence to ACOG/CDC guidelines for GBS prophylaxis can be challenging in clinical practice.
• Lapses in prophylaxis are often associated with preterm delivery and penicillin-allergic patients.

Purpose of the Study:

• To develop and implement a dynamic order set for Group B Streptococcus (GBS) prophylaxis.
• To enhance adherence to the American College of Obstetricians and Gynecologists/Centers for Disease Control and Prevention (ACOG/CDC) guidelines.
• To evaluate the impact of a dynamic order set on GBS prophylaxis adherence.

Main Methods:

• A dynamic order set was developed based on CDC guidelines and integrated into electronic medical records.
• The order set was piloted in an obstetric unit and subsequently rolled out across multiple hospitals.
• Adherence rates were compared before and after implementation using chi-squared tests, analyzing electronic medical record data.

Main Results:

• Implementation of the dynamic order set led to a significant increase in appropriate GBS prophylaxis for preterm and unknown GBS status patients (88.7% to 99.1%, p < 0.001).
• Appropriate use of clindamycin and vancomycin increased significantly (64.4% to 92.3%, p < 0.001).
• A decrease in clindamycin use for patients without sensitivity testing was observed.

Conclusions:

• Routine use of a dynamic labor/induction order set is associated with high and improved adherence to GBS prophylaxis guidelines.
• Dynamic electronic medical record order sets can effectively improve adherence to clinical guidelines.
• The intervention demonstrated a positive impact on GBS prophylaxis practices in obstetric care.