Providence Women's and Children's Program, Providence Health and Services, Portland, Oregon.
Providence Clinical Informatics, Providence Health and Services, Renton, Washington.
Am J Perinatol. 2024 May;41(S 01):e3124-e3132. doi: 10.1055/a-2196-6078. Epub 2023 Oct 23.
To develop and implement a Group B Streptococcal (GBS) dynamic order set to improve adherence to the American College of Obstetricians and Gynecologists/Centers for Disease Control and Prevention (ACOG/CDC) guidelines.
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 obstetric unit. Following the pilot and incorporation of the 2019 ACOG update of the CDC guidelines, the order set was rolled out in five 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 four 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 were obtained from discrete order set EMR data elements. Adherence to the guidelines before and after were compared using chi-squared test.
There were 7,114 deliveries before implementation and 4,502 after implementation. 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 (88.7-99.1%, < 0.001). More patients were reported to have a penicillin allergy before implementation than after implementation (14.7 vs. 11.1%, respectively, = 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%, = 0.18), an increase in the appropriate use of clindamycin and vancomycin (64.4 vs. 92.3%, < 0.001) and a decrease in clindamycin use in those without sensitivity testing.
Routine universal use of a dynamic admission labor/induction order set was associated with high and improved adherence to GBS prophylaxis guidelines.
· Lapses in GBS prophylaxis are associated with early-onset GBS disease.. · Preterm delivery and penicillin allergic patients are commonly associated with lapses in prophylaxis.. · Dynamic EMR order set use can improve adherence to clinical guidelines..
制定并实施 B 型链球菌（GBS）动态医嘱集，以提高对美国妇产科医师学会/疾病控制与预防中心（ACOG/CDC）指南的依从性。
一组信息技术和临床专家开发了一个动态医嘱块。内容模仿了 CDC“预防 GBS”移动应用程序。然后将其嵌入分娩/引产医嘱集，并在一个高容量产科单位进行试点。在试点和纳入 2019 年 ACOG 对 CDC 指南的更新后，该医嘱集在一个大型医疗系统的五个额外医院中推出。试点医院和四个额外医院均有实施前后 GBS 预防性能的相关信息。实施前的信息通过电子病历（EMR）实验室和药房数据获得，并通过手动图表审查进行补充。实施后的信息来自离散医嘱集 EMR 数据元素。使用卡方检验比较实施前后的指南依从性。
实施前有 7114 例分娩，实施后有 4502 例。早产分别发生在 6.8%和 6.9%的患者中。实施后，对早产患者（GBS 阳性和未知）的治疗更加恰当（88.7-99.1%，<0.001）。实施前报告青霉素过敏的患者多于实施后（分别为 14.7%和 11.1%，=0.01）。实施后观察到治疗相关的变化包括报告高风险过敏的比例无显著下降（50.3%和 41.9%，=0.18），克林霉素和万古霉素的合理使用增加（64.4%和 92.3%，<0.001），以及无敏感性测试患者克林霉素使用减少。
常规使用动态入院分娩/引产医嘱集与 GBS 预防指南的高依从性和改善依从性相关。
· GBS 预防措施的失误与早发性 GBS 疾病有关。
· 早产和青霉素过敏患者通常与预防措施失误有关。
· 使用动态 EMR 医嘱集可以提高对临床指南的依从性。
