Use of an Early Onset-Sepsis Calculator to Decrease Unnecessary NICU Admissions and Increase Exclusive Breastfeeding
| Autor: | Elizabeth Pesek, Margie Bridges, Michele L. McRae, Shilpi Chabra |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Psychological intervention Breastfeeding Critical Care Nursing Chorioamnionitis Pediatrics Sepsis 03 medical and health sciences 0302 clinical medicine Practice change Early onset sepsis Pregnancy Intensive Care Units Neonatal 030225 pediatrics Maternity and Midwifery Humans Medicine Retrospective Studies 030219 obstetrics & reproductive medicine business.industry Infant Newborn Antibiotic exposure Antibiotic Prophylaxis medicine.disease Community hospital Breast Feeding Emergency medicine Female Neonatal Sepsis business |
| Zdroj: | Journal of Obstetric, Gynecologic & Neonatal Nursing. 48:372-382 |
| ISSN: | 0884-2175 |
| DOI: | 10.1016/j.jogn.2019.01.009 |
| Popis: | Objective To evaluate the effects of use of the Kaiser Neonatal Early-Onset Sepsis Calculator (NEOSC) on NICU admissions, laboratory testing, antibiotic exposure, and exclusive breastfeeding (EBF) rates in full-term neonates exposed to chorioamnionitis. Design Quality improvement project with review of retrospective data. Setting/Local Problem In this single-site, community hospital with approximately 4,000 births per year, all neonates exposed to chorioamnionitis required NICU admission, laboratory evaluation, and empiric antibiotics. Participants Term neonates born to mothers diagnosed with chorioamnionitis identified through the International Classification of Diseases, Tenth Revision codes based on the discharge diagnosis. Intervention/Measurements The baseline retrospective analysis included calculation of sepsis risk with the Kaiser NEOSC through a chart review of neonates exposed to chorioamnionitis from January 1, 2015, to December 31, 2016. We compared the risk for sepsis with actual laboratory testing and antibiotic use and examined EBF before implementation of the use of the NEOSC. Implementation began January 2017; postintervention data were examined at 6 months and 1 year. All cases of neonates exposed to chorioamnionitis after the intervention were reviewed for use of the NEOSC, NICU admission/readmission for sepsis, laboratory testing, use of antibiotics, and EBF. Results In the 12 months after NEOSC use was implemented, NICU admissions, laboratory testing, and antibiotic use decreased. Among all neonates exposed to chorioamnionitis after implementation (N = 74), 68 (93%) were not admitted to the NICU, and only 8 (11%) required laboratory evaluation. Rates of EBF in neonates exposed to chorioamnionitis increased from less than 10% to greater than 50% after implementation. The length of the NICU stay for neonates exposed to chorioamnionitis decreased from an average of 138 to 12 days with no negative consequences. Conclusion Most neonates exposed to chorioamnionitis appeared well and did not require NICU admission, laboratory testing, or antibiotic therapy. Rates of EBF improved after use of NEOSC was implemented. The practice change helped prevent adverse consequences, such as painful interventions and separation of the mother and neonate. No neonates were readmitted for sepsis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|