Nurs Womens Health. 2023 Jun;27(3):201-210. doi: 10.1016/j.nwh.2023.01.009. Epub 2023 Apr 18.
To safely reduce unnecessary antibiotic exposure in neonates exposed to chorioamnionitis and inadequately treated Group B Streptococcus (GBS) using the early-onset sepsis (EOS) calculator for risk stratification and a 36-hour antibiotic duration.
Evidence-based quality improvement initiative.
SETTING/LOCAL PROBLEM: Obstetric service at a midsized military treatment facility with approximately 2,000 births annually and no standard process for neonatal EOS risk assessment.
Clinical nurse specialist, physicians, nursing leadership, unit-level nursing champions, and nurses assigned to the mother-baby and labor and delivery units.
INTERVENTION/MEASUREMENTS: An interdisciplinary working group created a protocol to institute an EOS risk assessment calculator, a note for the electronic heath record, and interdisciplinary education for all staff providing care to neonates in our facility.
Before implementation of the EOS calculator, 97.6% of neonates exposed to chorioamnionitis or inadequate maternal GBS treatment received antibiotics; after implementation, the mean rate dropped to 32%. Exclusive breastfeeding rates before discharge in neonates exposed to chorioamnionitis or inadequate maternal GBS treatment also increased during this time, from 40% to a mean of 89%. After implementation, there were no readmissions to our institution for culture-proven sepsis within 14 days of discharge.
Multidisciplinary team-led implementation of the EOS calculator and of shortened antibiotic duration were associated with safely reduced antibiotic exposure in well-appearing neonates exposed to chorioamnionitis and GBS. In addition, dramatically improved rates of exclusive breastfeeding at discharge were observed in this population.
通过使用早期发病的脓毒症（EOS）计算器进行风险分层和 36 小时抗生素持续时间，安全减少因暴露于绒毛膜羊膜炎和治疗不充分的 B 型链球菌（GBS）的新生儿不必要的抗生素暴露。
循证质量改进倡议。
背景/当地问题：在一个中型军事治疗设施的产科服务中，每年约有 2000 名婴儿出生，并且没有新生儿 EOS 风险评估的标准流程。
临床护理专家、医生、护理领导、单位级护理冠军以及分配到母婴和分娩单位的护士。
干预/措施：一个跨学科工作组制定了一项协议，以实施 EOS 风险评估计算器、电子健康记录的说明以及为我们设施中所有照顾新生儿的工作人员提供跨学科教育。
在实施 EOS 计算器之前，97.6%暴露于绒毛膜羊膜炎或治疗不充分的母体 GBS 的新生儿接受了抗生素治疗；实施后，平均率降至 32%。在此期间，暴露于绒毛膜羊膜炎或治疗不充分的母体 GBS 的新生儿出院前的纯母乳喂养率也有所增加，从 40%增加到平均 89%。实施后，在出院后 14 天内，我们机构没有因培养证实的败血症而再次入院。
多学科团队领导的 EOS 计算器的实施和抗生素持续时间的缩短与安全减少了在外观良好的暴露于绒毛膜羊膜炎和 GBS 的新生儿中的抗生素暴露有关。此外，在该人群中观察到纯母乳喂养率显著提高。
