Practicing the revised hyperbilirubinemia guidelines published by the American Academy of Pediatrics (AAP) significantly improved the timely diagnosis of hemolytic disease of the fetus and newborn (HDFN) in a healthcare facility, according to results of a recently published study in the Journal of Nursing Care Quality.
The authors aimed to incorporate AAP guidelines into the daily practices of a large medical center in the southeast of the United States. They used an approach called the Plan-Do-Study-Act (PDSA).
PDSA is a four-step cyclic program for implementing processes which consists of identifying a goal (plan), implementing the plan on a small scale (do), analyzing the data after the first try (study) and deciding whether to adopt the plan based on the results (act).
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The most important change in clinical practice introduced in the protocol was to give nurses more responsibility in informing the physician of the need for further testing. The nurses had to tell the provider when the mother had a positive or unknown antibody test, a history of HDFN, or if there were any problems with cord blood type analysis.
After the first cycle, the providers expressed a need to further explain to the nurses the scenarios that required further notification. Therefore, the authors created a clinical decision chart available to both nurses and providers.
After three PDSA cycles, researchers observed a 3% increase in cord blood sent to the laboratory, over the following 10 months the number increased to 9%. Furthermore, there was a significant decrease in missed opportunities to test blood cord samples.
“The initiative demonstrated that, while beneficial, clinical pathways and tailored educational and clinical tools alone may not be sufficient for carrying out this recommendation,” the authors concluded. “To promote increased practice uptake and sustainability, medical centers should integrate monitoring of this population in regularly evaluated hospital quality improvement metrics and may consider using CDS.”
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