Improvement in Rates of Preterm Infant Hypothermia by the Implementation of a Best Practice Bundle

Abstract

Objective To decrease the number of preterm infants with hypothermia on admission to the NICU by improving delivery room management. Design A best practice bundle was developed for preterm infants. This included the use of heated mattress pads for all infants 36‐weeks gestational age or less and polyethylene bags for infants 28‐weeks gestational age or fewer. Additionally, to prevent convective and conductive heat loss, preterm infants were not weighed in the delivery room, and operating room temperatures were set to 25 degrees C. Sample Data were collected for 300 preterm neonates admitted to the NICU between January 2013 and June 2014. Methods Using plan‐do‐check‐act (PDCA) methodology, an interprofessional team reviewed the literature, developed and implemented an evidence‐based protocol, and evaluated outcomes. Normal admission temperature was defined as 36.5 degrees C or greater within one hour of birth. Implementation Strategies All nursing and physician staff who attended births were educated on the significance of infant hypothermia and the bundle components. Following implementation of the bundle, outcomes were tracked and disseminated on a monthly basis. Outliers were analyzed and debriefs with the nursing and physician staff were conducted. Results The retrospective baseline data included 45 infants: 10 (22%) had admission temperatures of 36.5 degrees C or greater. Postimplementation, there was a steady improvement in admission temperatures. By the third quarter of 2014, 68% of infants in had admission temperatures of 36.5 degrees C or greater. For the low‐birth‐weight infants tracked in the Vermont Oxford Network (VON) database, for the 3 years prior to the bundle implementation, we performed at 3.8%, 3.10%, and 14.3%. The year postimplementation, of 12 VLBW neonates, 75% met the standard for temperature on admission to NICU. Conclusion/Implications for Nursing Practice Successful implementation of this project required a commitment from the obstetric and neonatal teams. Although it is clearly our responsibility to take admission temperatures and monitor various physiologic parameters in individual neonates, it is equally incumbent on the team to analyze aggregate data indicators to monitor overall performance. Data dissemination has been a crucial factor in maintaining awareness of this problem and providing the impetus for continued use of the bundle elements. In addition, conducting a case by case analysis of outliers is essential for ensuring that any gaps in performance are recognized and rectified by providing feedback to individual providers. To decrease the number of preterm infants with hypothermia on admission to the NICU by improving delivery room management. A best practice bundle was developed for preterm infants. This included the use of heated mattress pads for all infants 36‐weeks gestational age or less and polyethylene bags for infants 28‐weeks gestational age or fewer. Additionally, to prevent convective and conductive heat loss, preterm infants were not weighed in the delivery room, and operating room temperatures were set to 25 degrees C. Data were collected for 300 preterm neonates admitted to the NICU between January 2013 and June 2014. Using plan‐do‐check‐act (PDCA) methodology, an interprofessional team reviewed the literature, developed and implemented an evidence‐based protocol, and evaluated outcomes. Normal admission temperature was defined as 36.5 degrees C or greater within one hour of birth. All nursing and physician staff who attended births were educated on the significance of infant hypothermia and the bundle components. Following implementation of the bundle, outcomes were tracked and disseminated on a monthly basis. Outliers were analyzed and debriefs with the nursing and physician staff were conducted. The retrospective baseline data included 45 infants: 10 (22%) had admission temperatures of 36.5 degrees C or greater. Postimplementation, there was a steady improvement in admission temperatures. By the third quarter of 2014, 68% of infants in had admission temperatures of 36.5 degrees C or greater. For the low‐birth‐weight infants tracked in the Vermont Oxford Network (VON) database, for the 3 years prior to the bundle implementation, we performed at 3.8%, 3.10%, and 14.3%. The year postimplementation, of 12 VLBW neonates, 75% met the standard for temperature on admission to NICU. Successful implementation of this project required a commitment from the obstetric and neonatal teams. Although it is clearly our responsibility to take admission temperatures and monitor various physiologic parameters in individual neonates, it is equally incumbent on the team to analyze aggregate data indicators to monitor overall performance. Data dissemination has been a crucial factor in maintaining awareness of this problem and providing the impetus for continued use of the bundle elements. In addition, conducting a case by case analysis of outliers is essential for ensuring that any gaps in performance are recognized and rectified by providing feedback to individual providers.