Abstract
Objective To develop and implement a Group B Streptococcal (GBS) dynamic order set to improve
adherence to the American College of Obstetricians and Gynecologists/Centers for Disease
Control and Prevention (ACOG/CDC) guidelines.
Study Design A team of information technology and clinical experts developed a dynamic order block.
The content was patterned after the CDC “Prevent GBS” mobile app. It was then embedded
in the labor and delivery/induction order set and piloted at a single high-volume
obstetric unit. Following the pilot and incorporation of the 2019 ACOG update of the
CDC guidelines, the order set was rolled out in five additional hospitals within a
region of a large health system. Information on GBS prophylaxis performance before
and after implementation was available for the pilot site and four of the additional
hospitals. Information before implementation was obtained electronically from electronic
medical record (EMR) laboratory and pharmacy data and supplemented by manual chart
review. Postimplementation data were obtained from discrete order set EMR data elements.
Adherence to the guidelines before and after were compared using chi-squared test.
Results There were 7,114 deliveries before implementation and 4,502 after implementation.
Preterm delivery occurred in 6.8 and 6.9%, respectively. There was an increase in
appropriate treatment of preterm patients (positive and unknown GBS) delivering after
implementation (88.7–99.1%, p < 0.001). More patients were reported to have a penicillin allergy before implementation
than after implementation (14.7 vs. 11.1%, respectively, p = 0.01). Associated changes in therapy noted after implementation included a nonsignificant
decrease in the proportion reporting a high-risk allergy (50.3 vs. 41.9%, p = 0.18), an increase in the appropriate use of clindamycin and vancomycin (64.4 vs.
92.3%, p < 0.001) and a decrease in clindamycin use in those without sensitivity testing.
Conclusion Routine universal use of a dynamic admission labor/induction order set was associated
with high and improved adherence to GBS prophylaxis guidelines.
Key Points
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Lapses in GBS prophylaxis are associated with early-onset GBS disease.
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Preterm delivery and penicillin allergic patients are commonly associated with lapses
in prophylaxis.
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Dynamic EMR order set use can improve adherence to clinical guidelines.
Keywords
clinical decision support - early-onset GBS disease - EMR decision aid - EMR decision
aid - GBS antibiotic prophylaxis - GBS prophylaxis in penicillin allergy
