KERNICTERUSASANEVEREVENTFORNEWBORNS.ppt

Newborn Jaundice and Kernicterus Condition: Most newborn infants are at risk for jaundice during the first week after birth. Problem: Usually benign; but, when unmonitored or untreated, it may progress to severe hyperbilirubinemia (often, the infant is at home). Intervention: Severe neonatal hyperbilirubinemia is the most easily treatable and preventable cause of neonatal brain damage (kernicterus). Current Sigma level for Newborn Jaundice Management TSB level 25 mg/dL (“close call”) Incidence: 1 in 700 (1970s) Sigma level: 4.5 Incidence: 1 in 600 (2000) Sigma level: 4.0 Readmission for Jaundice Rates Rate: 27.7 per 1000 live-births Sigma level: 4.0 (1988-1988) Expectations: Sigma Level for Newborn Jaundice Management TSB level 30 mg/dL (Sentinel event) Incidence: 142 to 3 in 1,000,000 births Sigma level: 6.0 Readmission for Jaundice Rates Rate: 2,770 to 3 per 1,000,000 live births Sigma level: 6.0 (1988-1988) Can we apply Six Sigma to a newborn healthcare issue? Identify the issue: societal awareness of kernicterus (CDC, PICK) Characterize the problem: adverse outcome with high bilirubin levels (CDC, AAP, JCAHO, AHRQ) Optimal solution: pre-discharge screening and targeted follow-up in the first week (AAP) System-level change: family and nursing empowerment (CDC, AAP, AWOHNN, PICK) Measure impact on outcome: public health domain Maintain surveillance: A national strategy Measurement of Bilirubin TcB: BiliChek? / JM-103? devices TSB: at individual hospital laboratories Inter-and intra-institution calibration Actual variance values: 2 to 3%. Jerusalem’s Hospital-community Initiative for Newborn Jaundice Management Key health-societal practices: Transformation Lactation Support: counselors, access, videos, aids. Pre-discharge Data Jaundice screening and access to TSB/TcB screening Pre-discharge risk assessment for hyperbilirubinemia Explicit Parent education curriculum (interactive and video) Follow-up Services Location of return visits (hospital supervised)