ANALISIS JURNAL CLINICAL PATHWAY

INTERNASIONAL & NASIONAL

DENGAN 13 ITEM DAN PICO

Oleh:
Kelompok 4A
Semester VIII

PROGRAM STUDI S1 KEPERAWATAN

FAKULTAS KEPERAWATAN ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH BANJARMASIN
2019
PENYUSUN
No. Nama NPM
1. Andro Fugha Nabiring 1614201120612
2. Abdul Hadi 1614201120600
3. Intan Nur Karimah 1614201120607
4. Lily Soleha R 1614201120609
5. Bella Aldila Erlida 1614201120641
6. Prayugi Pangesti 1614201120623
7. Monika Priyanti 1614201120615
8. Najlianti Rahmah 1614201120617
9. Siti Niswatin Hasanah 1614201120642
10. Saidah 1614201120652
 ANALISIS JURNAL 13 ITEM

1. Judul Penelitian:
Reducing Invasive Care For Low-risk Febrile Infants Through
Implementation Of a Clinical Pathway

2. Alasan Pengambilan Judul

Risk stratification can be used to indentify low-risk infants who can be
managed as outpatitens without lumbar pucure (LP) or antibiotics.

3. Tempat dan Waktu Penelitian

Tempat Penelitian:
Waktu Penelitian:

4. Peneliti dan Alamat

Nama Peneliti:
- Kathryn E. Kasmire
- Eric C. Hoppa
- Pooja P. Patel
- Kelsay N. Boch
- Tina Sacco
- Ilana Y. Waynik

Alamat Jurnal:

http://pediatrics.aappublications.org/content/143/3/e20181610

Abstrak

a. Tujuan
Our objective was to reduce invasive interventions for febrile infants aged
29 to 60 days at low risk for serious bacterial infection (SBI) through
 implementation of a clinical pathway supported by quality improvement
(QI).
b. Desain Penelitian

c. Populasi Penelitian
The study population consisted of febrile infants aged 29 to 60 days
meeting inclusion criteria for the febrile-infant clinical pathway: fever
$38.0°C (rectal; before arrival or in the ED) and gestational age $37
weeks. Exclusions included evaluation initiated at an outside ED or recent
previous ED visit, history of immunodeficiency, identified focal infection,
underlying chronic medical disease, current antibiotic therapy, gestational
age ,37 weeks, or a clinical diagnosis of bronchiolitis.

d. Tehnik Pengumpulan Data

e. Hasil Penelitian
Of 350 included patients, 220 were pre- and 130 were postpathway
implementation. With pathway implementation in July 2016, invasive
interventions decreased significantly in low-risk infants, with LPs
decreasing from 32% to 0%, antibiotic administration from 30% to
1%, and hospital admission from 17% to 2%. Postimplementation,
there were 0 SBIs in lowrisk infants versus 29.2% in high-risk
infants. The percentage of high-risk patients receiving care per
pathway remained unchanged. Improvement was sustained for 12
months through QI interventions, including order-set development
and e-mail reminders.
f. Kesimpulan
Implementation of a clinical pathway by using QI methods resulted in
sustained reduction in invasive interventions for low-risk febrile infants
 without missed SBIs. Clinical pathways and QI can be key strategies in
the delivery of evidence-based care for febrile infants.
g. Jumlah Kata

h. Kata Kunci

5. Pendahuluan
Significant variation in management of febrile infants exists both nationally
and within our institution. Risk stratification can be used to identify low-risk
infants who can be managed as outpatients without lumbar puncture (LP) or
antibiotics. Our objective was to reduce invasive interventions for febrile
infants aged 29 to 60 days at low risk for serious bacterial infection (SBI)
through implementation of a clinical pathway supported by quality
improvement (QI).
6. Metode Penelitian
The evidence-based clinical pathway was developed and implemented by a
multidisciplinary team with continuous-process QI to sustain use. Low-risk
infants who underwent LP, received antibiotics, and were admitted to the
hospital were compared pre- and postpathway implementation with SBI in
low-risk infants and appropriate care for highrisk infants as balancing
measures.
7. Instrument Penelitian

8. Saran

9. Kaidah Penulisan
10. Referensi
1. Krauss BS, Harakal T, Fleisher GR. The spectrum and frequency of
illness presenting to a pediatric emergency department. Pediatr
Emerg Care.
2. 1991; 7(2):67–71 2. Nelson DS, Walsh K, Fleisher GR. Spectrum and
frequency of pediatric illness presenting to a general community
hospital emergency department. Pediatrics. 1992;90(1, pt 1): 5–10.
3. Dagan R, Powell KR, Hall CB, Menegus MA. Identification of infants
unlikely to have serious bacterial infection although hospitalized for
suspected sepsis. J Pediatr. 1985;107(6):855–860
4. 4. Dagan R, Sofer S, Phillip M, Shachak E. Ambulatory care of
febrile infants younger than 2 months of age classified as being at low
risk for having serious bacterial infections. J Pediatr.
1988;112(3):355–360
5. Baskin MN, O’Rourke EJ, Fleisher GR. Outpatient treatment of
febrile infants 28 to 89 days of age with intramuscular administration
of ceftriaxone. J Pediatr. 1992;120(1):22–27
6. Baker MD, Bell LM, Avner JR. Outpatient management without
antibiotics of fever in selected infants. N Engl J Med.
1993;329(20):1437–1441
7. Baker MD, Bell LM, Avner JR. The efficacy of routine outpatient
management without antibiotics of fever in selected infants.
Pediatrics. 1999;103(3):627–631
8. Huppler AR, Eickhoff JC, Wald ER. Performance of low-risk criteria
in the evaluation of young infants with fever: review of the literature.
Pediatrics. 2010;125(2):228–233
9. Paxton RD, Byington CL. An examination of the unintended
consequences of the rule-out sepsis evaluation: a parental perspective.
Clin Pediatr (Phila). 2001; 40(2):71–77
10. Pantell RH, Newman TB, Bernzweig J, et al. Management and
outcomes of care of fever in early infancy. JAMA. 2004;291(10):1203–
1212
11. Aronson PL, Thurm C, Alpern ER, et al; Febrile Young Infant
Research Collaborative. Variation in care of the febrile young infant
,90 days in US pediatric emergency departments. Pediatrics.
2014;134(4):667–677
12. Greenhow TL, Hung YY, Pantell RH. Management and outcomes of
previously healthy, full-term, febrile infants ages 7 to 90 days.
Pediatrics. 2016;138(6):e20160270
13. Jain S, Cheng J, Alpern ER, et al. Management of febrile neonates in
US pediatric emergency departments. Pediatrics. 2014;133(2):187–
195
14. Greenhow TL, Hung YY, Herz AM. Changing epidemiology of
bacteremia in infants aged 1 week to 3 months. Pediatrics.
2012;129(3). Available at: www.pediatrics.org/cgi/content/full/
129/3/e590
15. Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH. The
changing epidemiology of serious bacterial infections in young
infants. Pediatr Infect Dis J. 2014;33(6):595–599
16. Baraff LJ. Management of fever without source in infants and
children. Ann Emerg Med. 2000;36(6):602–614
17. Byington CL, Reynolds CC, Korgenski K, et al. Costs and infant
outcomes after implementation of a care process model for febrile
infants. Pediatrics. 2012;130(1). Available at: www.
pediatrics.org/cgi/content/full/130/1/ e16
18. Jaskiewicz JA, McCarthy CA, Richardson AC, et al; Febrile Infant
Collaborative Study Group. Febrile infants at low risk for serious
bacterial infection–an appraisal of the Rochester criteria and
implications for management. Pediatrics. 1994;94(3):390–396
19. Byington CL, Enriquez FR, Hoff C, et al. Serious bacterial infections
in febrile infants 1 to 90 days old with and without viral infections.
Pediatrics. 2004;113(6):1662–1666
20. Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L;
European Group for Validation of the Step-by-Step Approach.
Validation of the “step-bystep” approach in the management of
young febrile infants. Pediatrics. 2016; 138(2):e20154381
21. Garra G, Cunningham SJ, Crain EF. Reappraisal of criteria used to
predict serious bacterial illness in febrile infants less than 8 weeks of
age. Acad Emerg Med. 2005;12(10):921– 925
22. Murray AL, Alpern E, Lavelle J, Mollen C. Clinical pathway
effectiveness: febrile young infant clinical pathway in a pediatric
emergency department. Pediatr Emerg Care. 2017;33(9): e33–e37
23. DeLaroche AM, Sivaswamy L, Farooqi A, Kannikeswaran N.
Pediatric stroke clinical pathway improves the time to diagnosis in an
emergency department. Pediatr Neurol. 2016;65:39–44
24. Mohan S, Nandi D, Stephens P, MʼFarrej M, Vogel RL, Bonafide CP.
Implementation of a clinical pathway for chest pain in a pediatric
emergency department. Pediatr Emerg Care. 2018; 34(11):778–782
25. Ramarajan N, Krishnamoorthi R, Barth R, et al. An interdisciplinary
initiative to reduce radiation exposure: evaluation of appendicitis in a
pediatric emergency department with clinical assessment supported
by a staged ultrasound and computed tomography pathway. Acad
Emerg Med. 2009;16(11): 1258–1265
26. Scarfone R, Gala R, Murray A, Funari M, Lavelle J, Bell L;
Children’s Hospital of Philadelphia. ED pathway for
evaluation/treatment of febrile young infants (0-56 days old).
Available at: www.chop.edu/clinical-pathway/febrileinfant-emergent-
evaluation-clinicalpathway. Accessed June 8, 2017
27. Bishop J, Ackley H, Beardsley E, et al; Seattle Children’s Hospital.
Neonatal fever pathway. 2017. Available at: www.
 seattlechildrens.org/pdf/neonatal-feverpathway.pdf. Accessed
September 17, 2017 28. Aronson PL, Thurm C, Williams DJ, et al;
Febrile Young Infant Research Collaborative. Association of clinical
practice guidelines with emergency department management of
febrile infants #56 days of age. J Hosp Med. 2015;10(6):358–365 29.
Swerkersson S, Jodal U, Åhrén C, Sixt R, Stokland E, Hansson S.
Urinary tract infection in infants: the significance of
28. low bacterial count. Pediatr Nephrol. 2016;31(2):239–245
29. Tullus K. Low urinary bacterial counts: do they count? Pediatr
Nephrol. 2016; 31(2):171–174
30. Benneyan JC, Lloyd RC, Plsek PE. Statistical process control as a
tool for research and healthcare improvement. Qual Saf Health Care.
2003;12(6): 458–464
31. Ambroggio L, Thomson J, Murtagh Kurowski E, et al. Quality
improvement methods increase appropriate
32. antibiotic prescribing for childhood pneumonia. Pediatrics.
2013;131(5). Available at: www.pediatrics.org/cgi/
content/full/131/5/e1623
33. Jennings RM, Burtner JJ, Pellicer JF, et al. Reducing head CTuse for
children with head injuries in a community emergency department.
Pediatrics. 2017;139(4):e20161349
34. Lavelle JM, Blackstone MM, Funari MK, et al. Two-step process for
ED UTI screening in febrile young children: reducing catheterization
rates. Pediatrics. 2016;138(1):e20153023

11. Implikasi Keperawatan

Implementation of a clinical pathway by using QI methods resulted in sustained

reduction in invasive interventions for low-risk febrile infants without missed
SBIs. Clinical pathways and QI can be key strategies in the delivery of evidence-
based care for febrile infants

12. Rekomendasi
A clinical pathway by using QI methods resulted in sustained reduction in
invasive interventions for low-risk febrile infants without missed SBIs.
Clinical pathways and QI can be key strategies in the delivery of evidence-
based care for febrile infants