Neonatal jaundice is a common condition that can result in acute bilirubin encephalopathy if not treated appropriately. Despite evidencebased guidelines for monitoring and treating hyperbilirubinemia, variation in care persists. Previously published quality improvement efforts have focused on monitoring of bilirubin levels in the newborn nursery and outpatient settings.
The goal of our project was to improve the care for infants admitted to the pediatric ward with unconjugated hyperbilirubinemia by using a series of interventions to create a standardized management approach. The 2004 American Academy of Pediatrics (AAP) guidelines entitled “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation” served as our standard of care.
For our baseline data, we reviewed all ward admissions with a principal diagnosis of hyperbilirubinemia from the first quarter 2010 (N = 28) to determine lengthofstay, compliance with AAP guidelines, and frequency of lactation consults offered to breastfeeding mothers. Regarding compliance with AAP guidelines, we created an AAP composite score (range 08, with perfect score = 8) that gave points for completing a standard workup (02), not checking a rebound bilirubin (02), discharging the patient at an appropriate bilirubin level (02), and not providing IV fluids unless documenting dehydration (02). We repeated postintervention chart reviews monthly during the first 6 months of 2011 (N = 44). From January to June 2011, our team implemented multiple interventions to improve care. Our first intervention was creation of a physician care guideline that was approved by the pediatric hospitalist group and used as an education tool for residents. Concurrently, our nursing champion created an education series that consisted of a PowerPoint presentation, nursing policy revision, and multiple inservice offerings to all nursing units. In March 2011, we added specific efforts to educate the nighttime admitting residents. At baseline, the average lengthofstay was 33 hours (range 1694). By June, our average length of stay was 28.4 hours (goal = 28 hours.) Our baseline AAP composite score was 4.8 (range 18), while our post intervention composite score averaged 7.4 (range 68). Finally, at baseline, only 50% of breastfeeding mothers were offered lactation consults. By June 2011, 100% of moms received a lactation consult. Conclusions: Our efforts to improve and standardize care of infants admitted with hyperbilirubinemia have been very successful. Recently we have implemented a hyperbilirubinemia admission order set. The impact of this intervention has not yet been assessed. Additionally, the sustainability of our efforts is unknown and will require further monitoring. Future efforts will focus on expansion of education to the emergency room and survey of pediatric residents and nurses on their knowledge and comfort with management of hyperbilirubinemia.
To cite this abstract:Campbell J, Krivchenia K, Tartaglia K. Improving the Inpatient Management of Neonatal Jaundice: Followup from Year 1. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97714. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/improving-the-inpatient-management-of-neonatal-jaundice-followup-from-year-1/. Accessed July 22, 2019.