A Quality Improvement Project to Decrease Serum Bilirubins and Increase Appropriate Phototherapy Use by Following the AAP Guidelines in a Well Nursery
Mary E. Flynn
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 postimplementation
was noted. Implementation of the AAP CPG resulted in decreased
lab costs and nursing time, and improved newborn care.