A quality project to improve compliance with AAP guidelines for inpatient management of neonatal hyperbilirubinemia.

OBJECTIVE: The goal of this study was to improve compliance with published guidelines regarding management of neonatal hyperbilirubinemia in infants admitted to a general pediatric hospital ward and to improve support for their breastfeeding mothers.

METHODS: This quality improvement project was conducted by using Plan-Do-Study-Act cycles and statistical process control methods. Study subjects were infants > 35 weeks' gestation admitted for hyperbilirubinemia to the general inpatient ward of a large, freestanding pediatric hospital. We developed and implemented a guideline for the inpatient management of jaundiced neonates, with ongoing feedback given to the faculty on group performance. Outcome measures included monthly compliance scores based on American Academy of Pediatrics (AAP) guidelines for management of neonates > 35 weeks' gestation and the percentage of admitted jaundiced, breastfeeding infants whose mothers received lactation consultation during hospitalization. To determine the AAP compliance score, we reviewed and assigned points to each patient admission for completion of a standard evaluation, avoidance of unnecessary intravenous (IV) fluids and peripheral IV line placement, avoidance of rebound bilirubin checks while in the hospital, and the bilirubin level at discharge.

RESULTS: Mean monthly AAP compliance scores increased from 60.5% of total possible points during the baseline period (January 2010-December 2010) to 90.4% during the intervention period (January 2011-December 2011). Lactation consultations increased from 48% during our baseline period to 63% during our early intervention period and to 90% during the last 5 months of our intervention. Length of stay was unchanged during the baseline and intervention periods.

CONCLUSIONS: Interprofessional collaboration between nurses and physicians combined with a thoughtful campaign to increase awareness of published guidelines were successful in improving the care of infants admitted with unconjugated hyperbilirubinemia.