IMPROVING PROPHYLACTIC TREATMENT OF GBS

POSITIVE OBSTETRICAL PATIENTS

Michelle BlythersQuality Improvement Project

Professional Development PerspectivesNursing 3192

January 29, 2014

Group B Streptococcus (GBS)

According to Verani, McGee, and Schrag (2010), GBS is the leading cause of sepsis in the early newborn period, which is defined as the first week of life.

The Centers for Disease Control and Prevention (CDC, 2010), has published revised guidelines for GBS disease prevention.

http://office.microsoft.com/en-us/images/results.aspx?qu=baby&CTT=1#ai:MP900448395

Group B Streptococcus (GBS)

A high priority should be placed on development of a vaccine for GBS as well as an accurate rapid diagnostic test for those patients that present in preterm labor (Valkenburg-van den Burg et al., 2010).

http://www.trcpodcast.com/wp-content/uploads/2013/11/vaccine.gif

• Swab lower vagina and rectum• Collect during 35-37 weeks gestation• Store specimen at 4°C • Process specimen within 24 hours• Intrapartum prophylactic antibiotic

therapy for at least 4 hours before delivery, depending on patient allergy or bacteria resistance

(CDC, 2010)

Current CDC Recommendations

PROBLEMS• Specimens are not collected at the

recommended time

• Specimens are not processed according to the guidelines

1. Sensitivity required if patient has penicillin (PCN) allergy

• Lack of communication among team members1. GBS status2. Patient allergies3. Timely medication orders

PROBLEMS

• Delayed medication administration1. Pharmacy lag time2. Nursing delay

• Lack of education1. Patients should acknowledge importance of

prenatal care at recommended intervals and timely arrival to hospital when in labor

2. Staff should review current guidelines and discuss any updates during each shift report

In an effort to reduce infant morbidity and mortality, we should ensure:

• Proper/timely specimen collection/processing

• No delay in antibiotic therapy/appropriate medication in relation to penicillin allergy and bacteria resistance

• Good communication between obstetrical team members

• Appropriate patient/staff education

Where are improvements needed?

Quality Improvement Team

• Obstetrical Nurses• Obstetrical Providers

1. Obstetricians/Family Practice2. Certified Nurse Midwives

• Residents• Pharmacy • Laboratory

• Committee selected to ensure adherence to guidelines

• Review Laboratory Protocol for GBS culture processing

• Review Clinic Protocol for GBS culture collection

• Ensure all obstetrical team members are educated on current guidelines

• Educate patients on importance of prenatal care and antibiotic therapy when culture is positive

• Audit deliveries monthly to track non-adherence to CDC guidelines

• Committee publishes report with recommendations for improvement

Action Plan

IMPROVING PROPHYLACTIC

TREATMENTOF GBS POSITIVE

OBSTETRICALPATIENTS

SPECIMEN STAFF

GBS PROTOCOL PROCESS IMPROVEMENT

Nurses

Physicians/Midwives/Residents

Processing within 24 hours

Appropriate Storage

Timely Collection

Penicillin

Clindamycin

Vancomycin

MEDICATION

35-37 weeks

4• C

Vaginal/Rectal swab

EDUCATION/COMMUNICATION

Pharmacy

Laboratory

For PCN allergy

For Clindamycin resistance

Current guidelines/Updates

Patient

Team Handoff/ Shift Report

Importance of prenatal care/timely hospital admission

Timely medication delivery

Include sensitivity if PCN allergy Follow processing guidelines

Timely medication administration

Follow protocols/educate patients

Summary

• Surveillance of appropriate prenatal screening for GBS– Timely collection, processing per guidelines

• Antibiotic therapy as recommended– Appropriate alternative as required due to allergy or

sensitivity– Timely administration at appropriate intervals– Reduced number of inadequately treated patients– Reduced number of newborns with GBS infection

Summary

• Education– Current guidelines/updates– Patient acknowledgment

• Communication– Timely/complete status report/plan between all

patient care team members

ReferencesCenters for Disease Control and Prevention. (2010). Prevention of Perinatal Group B Streptococcal Disease. Retrieved from http://www.cdc.gov/mmwr/pdf/rr/rr5910.pdf

Valkenburg-van den Berg, A., Houtman-Roelofsen, R., Oostvogel, P., Dekker, F., Dörr, P., & Sprij, A. (2010). Timing of group B streptococcus screening in pregnancy: a systematic review. Gynecologic And Obstetric Investigation, 69(3), 174-183. doi:10.1159/000265942

Verani, J., McGee, L., & Schrag, S. (2010). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR. Recommendations And Reports: Morbidity And Mortality Weekly Report. Recommendations And Reports / Centers For Disease Control, 59(RR-10), 1-36.