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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.
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 degree of jaundice in the first week of life (American Academy of Pediatrics [AAP], 1994; Mishra, Agarwal, Deorari, & Paul, 2008). These bilirubin levels are consistent with physiologic jaundice of the newborn and are expected to resolve uneventfully without treatment. Bilirubin levels that exceed the level of physiologic jaundice are generally described as hyperbilirubinemia and usually warrant close follow-up and/or treatment.
Determining a safe versus unsafe bilirubin level is an unpredictable task (Bhutani, Johnson, Schwoebel, & Gennaro, 2006), and despite significant research, there are still no absolute numbers that define unsafe bilirubin levels for...