Date of Graduation

Summer 8-15-2017

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Nancy Taquino

Second Advisor

Nancy Taquino

Third Advisor

Nancy Taquino

Abstract

Abstract

Global Aim: To improve infant thermoregulation within the first 24 hours of life of the high risk preterm and very low birth weight (VLBW) infant population in the NICU, thereby reducing rates of morbidity and mortality due to complications influenced by infant hypothermia. Project Aim: To reduce the rate of hypothermia at one hour and the first 24 hours of life in the target population of preterm neonates weighing less than 1500 grams with a gestational age less than 32 weeks from 9.5% to < 5% through the consistent use of a specific bundle of interventions applied in the labor and delivery setting, by December 2017. The aim of the current initiative is also to build on the success of the pilot program launched in 2015 by adding to the preliminary bundle of initiatives, and sustaining hard-won achievements by reinforcing education measures to the nursing and medical teams involved in the infant delivery and NICU admission process. Background: Hypothermia is a major factor in morbidity and mortality of low-birth-weight premature infants, and remains a grave concern for health care providers despite advances in technology designed to prevent it (Cordaro, Phalen, and Zukowski, 2012). Core temperatures of less than 36 degrees Celsius are associated with numerous complications in this patient population, including increased risk of infection, coagulation defects, metabolic acidosis, hypoglycemia, and respiratory distress (Leadford, Warren, Manasyan, Chomba, Salas, Schelonka, and Carlo, 2013). The Neonatal Intensive Care Unit (NICU) of KPSF has historically had the organization’s highest rate of hypothermia in babies 22 to 29 weeks’ gestational age admitted to the NICU, based on temperatures taken at the first hour of life (Walsh, Mancera, Parker, 2015). According to an Institute for Healthcare Improvement White Paper, using a bundle of evidence-based interventions to address a need for a particular patient population and care setting produces superior outcomes as opposed to implementing individual measures (Resar, Griffin, Haraden, and Nolan, 2012). It was therefore determined that a coordinated bundle of innovative measures based on evidence based practice must be put in place to address this serious threat to the well-being of our patients. A pilot study of a bundle of interventions aimed at the specific patient population of very low birthweight, premature infants was implemented in our NICU in 2015. This pilot program met a reduction of hypothermia rates by nearly 50% over the previous year (California Perinatal Quality Care Collaborative, 2017). Improvement Measures: The first process measure used is the sustainability of the preliminary bundle of measures. The balance measure to this is potential hyperthermia. The second process measure is the addition of a polyethylene wrap to cover the infant during delayed cord clamping, where applicable. The balance measure to this is lack of compliance due to conflicting priorities in the delivery room/operating room, as well as lack of sufficient team education. Tools Used: A fishbone chart was used to outline potential threats to the success of the project. Langley’s Change Theory was used in preparing the work environment for optimal outcomes. This incorporates improving the workflow, changing the work environment, enhancing relationships, and managing variation. PDSA cycles were used to implement and test changes. Results: We are proud of the fact that year to date in 2017, the NICU team has been able to improve its hypothermia rate to 3.8% due to their dedication to improved patient outcomes provided through this intervention bundle (California Perinatal Quality Care Collaborative, 2017). As we look ahead, our expanded aim includes increasing the scope of the patient population included in the focus of the bundle of interventions, thereby having the ability to reach a greater sector of our patients, and ultimately increasing the clinical, financial, and intangible impact of the project.

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