Quality and Clinical Outcomes Associated with a Gentamicin Use System Change for Managing Chorioamnionitis

Chorioamnionitis is an intra-amniotic infection with serious maternal and neonatal complications. Clinical studies suggest antibiotic administration before delivery reduces the risk of complications compared to after delivery. Our center implemented a standardized intrapartum gentamicin computerized provider order entry and dosage form dispensing system intended to improve treatment initiation efficiency in hospitalized obstetric patients. The primary objective of this retrospective study was to determine if these system changes were associated with decreased time from gentamicin ordering to administration in patients with chorioamnionitis. A secondary objective was to compare clinical outcomes before and after system changes. Classification and regression tree (CART) analyses was applied to identify key predictors. Results demonstrated a trend towards reduced time to administration in the post-implementation group. Clinical outcomes were not altered. CART analysis revealed that post-implementation assignment and length of membrane rupture predicted shorter time to gentamicin initiation. This study suggests that the specific system changes we implemented were safe and improved efficiency, but additional changes are needed to have a clinically significant impact.

[1]  S. Gelber,et al.  Evidence for the clinical management of chorioamnionitis. , 2012, Seminars in fetal & neonatal medicine.

[2]  W. Benitz.  Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues , 2011 .

[3]  Beth M DeRonne,et al.  Order Set to Improve the Care of Patients Hospitalized for an Exacerbation of Chronic Obstructive Pulmonary Disease. , 2016, Annals of the American Thoracic Society.

[4]  M. Phipps,et al.  Unexpected complications of low-risk pregnancies in the United States. , 2015, American journal of obstetrics and gynecology.

[5]  M. Monga,et al.  Intrauterine Infection and Preterm Labor , 1995, Infectious diseases in obstetrics and gynecology.

[6]  J. Hauth,et al.  Intrauterine infection and preterm delivery. , 2000, The New England journal of medicine.

[7]  B. Poindexter,et al.  Early Onset Neonatal Sepsis: The Burden of Group B Streptococcal and E. coli Disease Continues , 2011, Pediatrics.

[8]  Erik E. Abel,et al.  Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery. , 2016, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[9]  B. Poindexter,et al.  Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections , 2016, Pediatrics.

[10]  C. Rosenfeld,et al.  Intrapartum treatment of acute chorioamnionitis: impact on neonatal sepsis. , 1988, American journal of obstetrics and gynecology.

[11]  R. Gibbs,et al.  A Comparison of Intrapartum Versus Immediate Postpartum Treatment of Intra‐Amnio tic Infection , 1987, Obstetrics and gynecology.

[12]  G. Hankins,et al.  High Compared With Standard Gentamicin Dosing for Chorioamnionitis: A Comparison of Maternal and Fetal Serum Drug Levels , 2005, Obstetrics and gynecology.

[13]  C Michael Cotten,et al.  Early and Late Onset Sepsis in Late Preterm Infants , 2009, The Pediatric infectious disease journal.

[14]  G. Saade,et al.  Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis: Summary of a Workshop. , 2016, Obstetrics and gynecology.

[15]  D. Ballard,et al.  Implementing a standardized order set for community-acquired pneumonia: impact on mortality and cost. , 2009, Joint Commission journal on quality and patient safety.

[16]  R. Gibbs,et al.  A Randomized Trial of Intrapartum Versus Immediate Postpartum Treatment of Women With Intra‐Amniotic Infection , 1988, Obstetrics and gynecology.