Quality Improvement Initiative to Prevent Admission Hypothermia in Very-Low-Birth-Weight Newborns

Abstract

ObjectiveTo decrease rates of admission hypothermia (<36 °C) in very-low-birth-weight (VLBW) newborns (<1,500 g). DesignQuality improvement initiative. Setting/Local ProblemUrban, Level IV NICU with 32 patient beds. The number of VLBW newborns admitted with temperatures less than 36 °C was greater than in comparable NICUs in the Vermont Oxford Network. ParticipantsNeonates born in 2016 who weighed less than 1,500 g at birth. Intervention/MeasurementsBased on the literature and the needs of our unit, our team decided to focus efforts on equipment (chemical mattresses and polyurethane-lined hats for newborns who weighed <1,000 g and polyurethane-lined hats for newborns who weighed <1,500 g), staff education/awareness, and temperature documentation and workflow. Axillary temperature measurements for all neonates who weighed less than 1,500 g were tracked on admission. ResultsThe processes involved in this quality improvement initiative were successfully implemented, and use of new equipment began January 1, 2016. In 2016, only 9.6% (n = 7) of VLBW newborns were admitted with temperatures less than 36 °C, compared with 20.2% (n = 19) in 2015 and 32.4% (n = 24) in 2014 (p = .003). Overall, the mean admission temperature for neonates who weighed less than 1,500 g rose from 36.2 °C in 2014 to 36.6 °C in 2016 (p = .001). ConclusionWe reduced the number of VLBW neonates admitted with temperatures less than 36 °C and increased overall admission temperatures for neonates who weighed less than 1,500 g with the addition of polyurethane-lined hats and chemical mattresses.