1. I MPROVING PROPHYLACTIC TREATMENT OF GBS POSITIVE OBSTETRICAL PATIENTS Michelle Blythers Quality Improvement Project Professional Development Perspectives Nursing 3192 January 29, 2014

2. 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

3. 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

4. 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

5. P ROBLEMS 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 members 1.GBS status 2.Patient allergies 3.Timely medication orders

6. P ROBLEMS Delayed medication administration 1.Pharmacy lag time 2.Nursing delay Lack of education 1.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

7. 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?

8. Quality Improvement Team Obstetrical Nurses Obstetrical Providers 1.Obstetricians/Family Practice 2.Certified Nurse Midwives Residents Pharmacy Laboratory

9. 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

10. IMPROVING PROPHYLACTIC TREATMENT OF GBS POSITIVE OBSTETRICAL PATIENTS SPECIMENSTAFF 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/COMMUNICATI ON 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

11. 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

12. Summary Education – Current guidelines/updates – Patient acknowledgment Communication – Timely/complete status report/plan between all patient care team members

13. References Centers 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.