Effect of revised nursery orders on newborn preventive services.

OBJECTIVE Aspects of neonatal care that are the subject of evolving guidelines include hepatitis B virus (HBV) immunization; discharge follow-up recommendations; and prevention of perinatal group B streptococcal (GBS) disease. In 2007, a university hospital's standardized newborn nursery orders were changed to reflect current recommendations in these areas. The objective of the study was to determine the effect of new nursery orders on the quality of care provided to these newborns. METHODS The study was a retrospective review of medical records, birth certificates, and a computer database of 857 infants. The nursery orders changed in the following ways: (1) physicians had to "opt out" of HBV immunization; (2) discharge follow-up recommendations were based on American Academy of Pediatrics (AAP) recommendations; and (3) AAP recommendations for GBS were followed except blood cultures were not required for certain infants. RESULTS The percentage of infants receiving HBV immunizations increased from 74% in 2007 to 83% in 2008 (P = .0018). The percentage of infants whose mothers received antibiotics for GBS less than 4 hours before delivery and who received a complete blood count increased from 36% to 83% (P < .0001). The percentage of newborns who had discharge follow-up plans consistent with AAP recommendations did not change significantly. CONCLUSION A simple change in nursery orders was associated with significant improvement in newborn care.