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Pediatrics. 2019 Aug;144(2). pii: e20180262. doi: 10.1542/peds.2018-0262.

Using Quality Improvement to Implement a Standardized Approach to Neonatal Herpes Simplex Virus.

Author information

1
Divisions of Hospital Medicine.
2
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
3
Pediatric Emergency Medicine.
4
Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
5
Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
6
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
7
Infectious Diseases, and.
8
Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
9
Division of External Primary Care, Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware.
10
Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and.

Abstract

OBJECTIVES:

Neonatal herpes simplex virus (HSV) infections are associated with high mortality and long-term morbidity. However, incidence is low and acyclovir, the treatment of choice, carries risk of toxicity. We aimed to increase the percentage of patients 0 to 60 days of age who are tested and treated for HSV in accordance with local guideline recommendations from 40% to 80%.

METHODS:

This quality improvement project took place at 1 freestanding children's hospital. Multiple plan-do-study-act cycles were focused on interventions aimed at key drivers including provider buy-in, guideline availability, and accurate identification of high-risk patients. A run chart was used to track the effect of interventions on the percentage managed per guideline recommendations over time by using established rules for determining special cause. Pre- and postimplementation acyclovir use was compared by using a χ2 test. In HSV-positive cases, delayed acyclovir initiation, defined as >1 day from presentation, was tracked as a balancing measure.

RESULTS:

The median percentage of patients managed according to guideline recommendations increased from 40% to 80% within 8 months. Acyclovir use decreased from 26% to 7.9% (P < .001) in non-high-risk patients but did not change significantly in high-risk patients (73%-83%; P = .15). There were no cases of delayed acyclovir initiation in HSV-positive cases.

CONCLUSIONS:

Point-of-care availability of an evidence-based guideline and interventions targeted at provider engagement improved adherence to a new guideline for neonatal HSV management and decreased acyclovir use in non-high-risk infants. Further study is necessary to confirm the safety of these recommendations in other settings.

PMID:
31345997
DOI:
10.1542/peds.2018-0262

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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