A quality improvement project to decrease serum Bilirubins and increase appropriate phototherapy use by following the AAP guidelines in a well nursery

Hyperbilirubinemia is the most common problem in the newborn period, requiring hospitalization and medical attention (Alkalay, Bresee, & Simmons, 2010; Larson, 2008). Approximately 60% of all newborns will develop some [...]
The project purpose was to implement and evaluate the impact of adopting the American Academy of Pediatrics (AAP) Hyperbilirubinemia Clinical Practice Guideline (CPG) in a newborn nursery. The Model for Implementing Evidence-Based Practice guided this study. All newborns greater than or equal to 35 weeks' gestation admitted to the nursery during the two six-week periods were included in the study. ABO incompatible newborns and NICU admissions for greater than six hours were excluded. A nursing algorithm and risk factor tool were developed to assist nurses in the decision of when to obtain a newborn's bilirubin level. Anticipated outcomes included a decrease in the number of total serum bilirubins (TSBs) and an increase in the "the appropriate use" of phototherapy. Retrospective chart reviews were conducted pre- and post-implementation of the CPG. Both groups were equivalent in newborns with initially high transcutaneous bilirubins (TcBs), requiring a confirmatory TSB, and newborns treated with phototherapy. Significant differences were noted between the numbers of TSBs ordered for each jaundiced newborn by each group. The pre-implementation group had 99 TSBs obtained on 115 newborns, averaging 1.73 TSBs per newborn. Forty percent of these newborns received two or more TSBs before discharge. The post-implementation group had 157 TSBs obtained on 115 newborns, averaging 1.37 TSBs per newborn. Only 22.6% of these newborns received two or more TSBs before discharge. Additionally, a significant increase in "appropriate phototherapy" use post-implementation was noted. Implementation of the AAP CPG resulted in decreased lab costs and nursing time, and improved newborn care.