Preventing Kernicterus: A Comparison of Nurse and Provider Interpretation of American Academy of Pediatric Guidelines

Cavanagh, Maureen

Monday, 31 October 2011

Maureen Cavanagh, MS, MAHCM, RN
Women and Children's Services, St. Peter's Hospital, Albany, NY
Patricia Newell-Helfant, RN, MS, CPNP
Womena dn Children's Services, St. Peter's Hospital, Albany, NY

Learning Objective 1: discuss the differences in perception of risk and safe follow-up of serum bilirubin levels between nurses and providers.

Learning Objective 2: identify the components of a quality improvement program designed to prevent kernicterus.

In 2004 the American Academy of Pediatrics issued guidelines for prevention of kernicterus in the newborn. At that time, hospitals and professional organizations conducted education and developed policies and standard order sets to assure implementation. It seemed as thought the issue was finally resolved until an adverse event with the potential for harm occurred at one large community hospital with a Level 3 NICU. Investigation of the event led to the conclusion that there was inconsistent practice regarding discharge of infants with borderline or high bilirubin levels thereby increasing the potential for preventable hyperbilirubinemia or kernicterus.

This poster will outline the plan designed by 2 advanced practice nurses to identify the reasons for inconsistent interpretation of the guidelines by both physicians and nurses, improve the documentation of the assessment and plan for high bilirubin levels and provide targeted education for staff nurses and providers with an aim to decrease the number of infants readmitted for hyperbilirubinemia.

An anonymous survey was created and administered to both nurses and physicians caring for newborns in the full term nursery. The IRB approved survey included scenarios commonly encountered in newborns who had bilirubin levels in the moderate to high risk zones as defined in the AAP guidelines. Content validity of the survey scenarios was established by independent review of the tool by 2 additional advanced practice nurses and a pediatrician. Analysis of the survey is being completed to determine if the perception of risk differs between nursing and provider staff and to determine the level of discrepancy between the caregiver perception of risk and the actual risk as identified in the guidelines.

Recommendations for practice changes based on the survey results will be shared. Measurement of success will be demonstrated in a decrease in the number of infants requiring re-admission for treatment of hyperbilirubinemia.

See more of: Poster Session II
See more of: Oral Paper & Poster: Evidence-Based Practice Contest