Delayed Cord Clamping: A Multidisciplinary Approach

Abstract

Poster Presentation Purpose for the Program In evaluating adverse outcomes in our hospital, we recognized an opportunity to affect the rate of intraventricular hemorrhage (IVH) in infants born before 32 weeks gestation. Neonatal intensive care unit (NICU) nurses and neonatologists felt that preterm infants could benefit from delayed cord clamping (DCC) to reduce IVH rates by nearly 50%. Staff from labor and delivery (L&D) and the NICU partnered to develop and implement a process for DCC with the end goal of improving patient outcomes. Proposed Change To ensure success, an interdisciplinary team consisting of NICU and L&D nurses, neonatologists, obstetricians, and respiratory therapists was formed to develop a standardized process for cesarean and vaginal births. Implementation steps included establishing a policy for discussing essential steps needed to maintain normothermia of the infant, creating simulation videos for training on the process, and educating all physicians and staff within L&D and NICU. Implementation, Outcomes, and Evaluation A standardized approach to DCC was established by the multidisciplinary team. Using the Iowa model, benchmarking, and a current literature review, a policy was developed that included a clear set of exclusion criteria for all very‐low‐birth‐weight (VLBW) infants. We set a specific time frame for the delay in clamping the cord and most importantly established clear communication guidelines for prompting the delivery team to next steps. The team worked together to discuss obstacles faced during vaginal and cesarean births in ensuring normothermia of these infants. The team walked through the proposed process in a simulated environment to ensure that all barriers had been considered and developed a simulation video to disseminate consistent training for the L&D and NICU staff. Because of the work of this multidisciplinary team, the hospital has experienced great success with implementing a consistent DCC process. Implications for Nursing Practice Nurse involvement began at inception of this project and has continued through current implementation. The NICU staff actively communicated time frames to the delivery team, and labor and delivery nurses regulated the delivery room temperature and ensured consistent communication throughout each preterm birth. Although delayed cord clamping did not increase staff workload, it was a process change for the nurses and physicians. The team provided input to perfect the process and balance safety with practicality and efficiency.