After spending his career as a registered nurse and then a neonatal nurse practitioner in neonatal units across Louisiana and Texas, Martin Begnaud says he was interested in developing quality improvement initiatives within those systems.
He enrolled in UL Lafayette’s Doctor of Nursing Practice online program. The nationally-ranked program culminates with a rigorous Synthesis Project, through which students make lasting impacts on healthcare systems and outcomes within their communities and beyond.
Begnaud’s project aimed to reduce costs and improve patient care for an especially vulnerable population: newborns.
Begnaud works for a national healthcare company that partners with hospitals, health systems and healthcare facilities to offer clinical services, including neonatology services. The company maintains a database to allow clinicians to compare their units to similar units within the company.
“I knew our unit was an outlier with antibiotic use in the evaluation of early onset sepsis and newborns,” Begnaud says. “My initial question was: ‘What is contributing to the high antibiotic use in our unit?’”
Begnaud says unwarranted antibiotic use in newborns can be costly for both the healthcare system and for patient outcomes, having been associated with late onset sepsis, necrotizing enterocolitis, atopy, bronchopulmonary dysplasia, multidrug-resistant organisms and death.
He collected six months of data to evaluate antibiotic use trends and the factors driving extended antibiotic use. After performing a statistical analysis and ancillary lab tests, Begnaud was able to formulate new guidelines for antibiotic use in newborns.
In April 2018, Begnaud began educating providers and nurses to implement those guidelines along with a neonatal early onset sepsis calculator for newborns greater than 34 weeks gestation.
July began the project’s prospective period to collect data to compare to baseline collections. Begnaud says he was looking for outcomes, including:
- Reduction of overall antibiotic use
- Reduction of unwarranted antibiotic use beyond a 48-hour rule-out period
- Reduction of early onset sepsis evaluations and lab tests
“With the implementation of evidence based guidelines, we were able to reduce overall antibiotic treatment days, overall empiric use, and reduce unwarranted antibiotic use beyond 48-hour rule-out period,” he says. “With the introduction of the neonatal early onset sepsis calculator, we reduced empiric antibiotic use in that population, also.”
In addition to the potential impacts to patient care, an initial cost analysis showed a potential $300,000 reduction in cost for the healthcare system.
Throughout his research and coursework to earn his DNP, Begnaud balanced time with his wife and two children while also working “more than full-time,” at newborn intensive care units in rural Texas and Louisiana.
He says his family has cheered him on throughout the process.
“My wife and I graduated together from nursing school so she was familiar with my writing style and able to provide editorial corrections throughout this process,” Begnaud says.
“They supported me throughout, although they’ve seen me stress out and have some difficult moments at times.”
As Begnaud prepares to walk across the stage May 17 to accept his degree, he says his research and quality improvement implementation is ongoing.
“It’s just the beginning, to be honest,” he says. “Now my focus is on the sustainability of the quality improvement project and the dissemination of project through presentations and publications.”
Begnaud says earning his doctorate reinforced his belief in questioning assumptions in healthcare best practices.
“I think the DNP program provided a holistic perspective about healthcare,” he says. “As you advance in your career, you have adapt and change and question the way things were done in the past.
“I think change is difficult — it’s been difficult for me at times — but it should be ongoing and accepted in order to improve health care at the bedside.”
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