Purpose for the program: Each year approximately 60% of the 4 million newborns in the United States become clinically jaundiced.   The American of Academy of Pediatrics has instituted guidelines for the assessment and management of hyperbilirubenimia in newborns.  The purpose of this project was to develop an innovative approach to identify newborns at risk for hyperbilirubenimia at delivery and at 24hr of life and to improve neonatal outcomes for at risk infants with hyperbilirubenimia after discharge during weekend/holiday.  Most infants discharge at <72 hrs should be seen within 2 days of discharge.

Proposed change:  Previously, discharged infants with hyperbilirubenimia who required follow up on weekends and holidays were seen in the emergency room which delayed evaluation and treatment.  We sought to identify infants at risk and streamline the evaluation and treatment process by instituting a Weekend/holiday Bili Clinic on the 4WMotherBaby Unit.

Implementation, outcomes and evaluation: To identify infants at risk, we instituted collection of cord blood Type and Coombs at delivery for mothers with maternal blood type O Positive for RH negative blood types.  Furthermore, all newborns at 24hr of life had Transcutaneous Bilirubin (Tcb) performed and if the result > 6 a serum bilirubin specimen was collected. The goal was to identify those at risk for Hyperbilirubenimia and initiate treatment in a timely manner.

The weekend- holiday Bili clinic opened on April 2010.  During the week, newborn health care providers (Pediatrics or Family Medicine) identified newborns requiring outpatient follow up on the weekend-holiday and initiated the process for pre admission to the Bili Clinic, maintained a logbook, and informed parents of required follow up.  Parents received an information form with follow-up appointment to the Bili clinic from 8am-4pm.  As parents arrived for follow-up, the staff activated the Bili clinic process, notified newborn health care provider of newborn’s arrival and initiated procedures (weight, Tcb, or serum bilirubin) as requested.  Based on the results, the decision is made to provide further patient follow-up, discharge home, or admit the newborn for treatment. This process for at risk infants bypassed the emergency department and facilitated prompt treatment at the Bili clinic.

Implications for nursing practice:  Evaluation is ongoing based on patient comments, and efficiency of work flow for nursing staff.  Infants received phototherapy in a timelier manner thus increasing patient and nurse satisfaction; decreasing overall costs and promoting better outcomes for the patient.

Keywords:

Hyperbilirubenimia, phototherapy, Transcutaneous Bilirubin (Tcb), Bilirubin clinic