Date of Graduation

Summer 8-10-2018

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Ramon Jacom

Abstract

A common clinical concern for all newborns in the first few days of life is the risk of hyperbilirubinemia. Hyperbilirubinemia if left untreated can lead to permanent hearing loss, neurological dysfunction, and even irreversible brain damage called kernicterus. Bilirubin monitoring and early intervention can prevent these adverse events from occurring. Best practice recommends the use of transcutaneous bilirubin (TcB) monitoring on all term, low-risk newborns (>38 weeks gestation at birth) at 24-hours of life. Replacing total serum bilirubin (TSB) draws through a heel stick, with TcB assessments leads to utilization of evidence-based practice. The transcutaneous bilirubinometer is a non-invasive, effective way to monitor bilirubin levels for all full term, low-risk newborns.

Implementation of TcB assessment on a postpartum unit involved the creation of new policies and procedures (Appendix A) to instruct staff how to intervene with intermediate and high-risk newborns. Various risk factors influence a newborns risk of developing hyperbilirubinemia including: gestational age at birth, race, breastfed vs. bottle fed, prenatal care, and infection (Jaundice & Kernicterus, 2016). A standard of work (Appendix B), nomogram (Appendix C), and algorithms (Appendix D) were created for postpartum Registered Nurses to reference. These documents allow nurses to determine what interventions are necessary based on a neonate’s bilirubin level and age. In-service staff education was provided by the Clinical Nurse Leader (CNL) students to educate nurses on the use of the Dräger Jaundice Meter (JM)-105. Nurse’s confidence and competency in using the transcutaneous bilirubinometer was measured before and after in-service staff education through confidence scale surveys (Appendix E). Due to time constraints, post-test data has not been completed but the results are expected to show improved nurse confidence and competency in use of the Dräger JM-105. Following ten weeks of policy and procedure creation and in-service staff education, successful implementation of transcutaneous bilirubin monitoring was exhibited.

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