Quality Improvement Measures in Reducing Hypothermia Among At-risk Preterm Neonates in a Neonatal Intensive Care Unit

Abstract

Background Hypothermia is a significant concern in most neonatal units in both term and preterm, which increases the risk of mortality and morbidity. We aimed to reduce the incidence of hypothermia among at-risk preterm neonates upon admission to the neonatal intensive care unit (NICU) from a baseline of 75%-30% over 15 months. Methods This quality improvement study in a tertiary NICU implemented multiple plan-do-study-act (PDSA) cycles for all inborn neonates with a gestational age of less than 34 weeks or birth weight under 1500 g. The key outcome measure was the incidence of hypothermia, expressed as a percentage. Potential barriers to normothermia were evaluated using fishbone analysis and a key-driver diagram. Baseline data were collected over 3 months, and two PDSA cycles were performed over 18 weeks using a bundled approach and a sustenance phase over 9 months. Key interventions involved the optimization of environmental temperature at various locations, the use of polyethylene wraps for resuscitation, the proper use of transport incubators, and through raising awareness among healthcare professionals. Results A total of 319 neonates were part of the study. The baseline incidence of hypothermia (outcome measure) decreased from a median of 83% to 20.5% after two PDSA cycles and was sustained for over 9 months with reinforcement measures. Only two neonates had hyperthermia during the study period (balancing measure), and 96% compliance with documentation was achieved. Conclusions Quality improvement measures with simple policy reinforcement and a bundled approach can help reduce the incidence of hypothermia in at-risk preterm neonates.