Date of Graduation

Fall 12-15-2017

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions



Global Aim:

Between September 2017 and September 2018 we aim to reduce the rate of grade III and grade IV intraventricular hemorrhage (IVH) in infants less than or equal to 32 weeks gestation, or less than or equal to 1500 grams from 11% to 5%.

Project Aim:

Develop a best practice bundle for the Prevention of Intraventricular Hemorrhage with implementation of best practice of midline head positioning for infants less than or equal to 32 weeks gestation or less than or equal to 1500 grams by October 2017.


Level III, 64 bed Neonatal Intensive Care Unit

Quality Gap:

In August 2017, it was determined that total IVH numbers were increasing with the most significant increase among grade III and IV bleeds. This data combined with problem identification by the team led to the identification of a quality gap in existing strategies to reduce IVH.


Team-based, brain-focused care to monitor, diagnose, and treat neurologic conditions of the developing brain has the potential to improve outcomes in neonates with brain injuries (Glass, 2015). In addition to the cost of infant’s hospitalization, there is an estimated additional cost of $53, 602 if the infant is diagnosed with IVH (Adcock, 2014).


Twenty audits were performed daily for one week to determine if the IVH Guideline was present at the bedside of infants in the target population. Study team members completed daily bedside rounding to ensure the Tortle™ mid-liner was in use and positioned correctly. Testing and adaption PDSA cycles were used for both the IVH Guidelines and the Tortle™ Mid-liner. The results of the audit showed 80% of the infant’s had the IVH Guidelines at the bedside and 100% had the Tortle™ in place and positioned correctly. NICU team members completed 80% of the Tortle™ Evaluation Forms. Phase 2 of the project is aimed at minimizing pain and stress in these using an algorithm for pre-medication prior to intubation. This phase is planned for January 2018. The continuation of audits, education, and staff feedback will assist with staff engagement through phase 2 and 3. Successful implementation of each phase, with reporting of data to the team, will help sustain each phase of this project and maintain change, resulting in improved outcomes.


NICU- Neonatal Intensive Care Unit

Tortle™- Mid-liner positioning aide

IVH- Intraventricular Hemorrhage

VLBW- Very Low Birth Weight

ELBW- Extremely Low Birth Weight