Maternal Group B Streptococcus Prophylaxis Improvement Using an Electronic Medical Record Dynamic Order Set.

OBJECTIVE: Develop and implement a Group B Streptococcal (GBS) dynamic order set to improve adherence to ACOG/CDC prevention guidelines.

STUDY DESIGN: A team of information technology and clinical experts developed a dynamic order block. The content was patterned after the CDC "Prevent GBS" mobile app. It was then embedded in the labor and delivery/induction order set and piloted at a single high volume OB unit. Following the pilot and incorporation of the 2019 ACOG update of the CDC guidelines, the order set was rolled out in 5 additional hospitals within a region of a large health system. Information on GBS prophylaxis performance before and after implementation was available for the pilot site and 4 of the additional hospitals. Information before implementation was obtained electronically from electronic medical record (EMR) laboratory and pharmacy data and supplemented by manual chart review. Postimplementation data was obtained from discrete order set EMR data elements. Adherence to the guidelines before and after were compared using chi-squared test.

RESULTS: There were 7114 deliveries before implementation and 4502 after. Preterm delivery occurred in 6.8% and 6.9% respectively. There was an increase in appropriate treatment of preterm patients (positive and unknown GBS) delivering after implementation (88.7% to 99.1%, p <0.001). More patients were reported to have a penicillin allergy before implementation than after (14.7% vs 11.1% respectively, p=0.01). Associated changes in therapy noted after implementation included a nonsignificant decrease in the proportion reporting a high-risk allergy (50.3% vs 41.9%, p=0.18), an increase in the appropriate use of clindamycin and vancomycin (64.4% vs 92.3%, p<0.001) and a decrease in clindamycin use in those without sensitivity testing.

CONCLUSION: Routine universal use of a dynamic admission labor/induction order set was associated with high and improved adherence to GBS prophylaxis guidelines.