Improving Adherence to an Existing Protocol for Infants at Risk for Hypoglycemia

Background: Prolonged hypoglycemia and delays in treatment correlate with poor neurological outcomes and developmental delays in infants. Research shows that infants at risk can be managed successfully with proactive intervention and management until their bodies have compensated. Protocols enhance attention to early recognition and treatment to decrease risks of adverse outcomes. Nonadherence to an existing protocol appears to be multifactorial with an increased incidence of hypoglycemia in infants at risk and NICU admissions required for higher acuity of careMethods: A quality improvement project was conducted at a suburban, level II trauma hospital. Surveys were administered to staff to identify perceived barriers to their adherence of an existing hypoglycemia protocol. Development and implementation of two education modules, addressing infant hypoglycemia pathology, risk factors, and defined roles of individual units in protocol management, was administered to staff along with the creation and implementation of crib cards to improve protocol compliance and encourage family involvement. Post-education surveys were also administered to determine whether staff felt their individual knowledge had improved. Chart reviews were than conducted pre- and post-education and crib card implementation to determine if there were significant changes in protocol adherence among the staff. A Chi-squared test was conducted to compare pre- and post- intervention chart data for change. Results:A total of 228 infant charts were reviewed prior to project implementation and 233 were reviewed post-implementation. No significant change in staffs' identification of infants at risk for hypoglycemia and no change in incidence of hypoglycemia in at-risk infants following project implementation was found. There also was no significant change in protocol compliance among staff and infants requiring higher acuity of care.Conclusion:Due to project limitations and shortened evaluation time, no significant changes were seen following implementation of this project. Continuation of protocol reinforcement among staff, ongoing chart reviews to assess adherence to the protocol, and transparency of results with staff will be imperative to changing the unit culture and removing barriers to improve treatment.