Prevention of Hypothermia at Delivery in Infants Born Preterm at 28 to 34 Weeks Gestation Through Implementation of a Clinical Workflow Process

POSTER

Prevention of Hypothermia at Delivery in Infants Born Preterm at 28 to 34 Weeks Gestation Through Implementation of a Clinical Workflow Process Denise Rowley RN, BSN, DNP Student, Linda Hofmann PhD, RN Key Findings: Improved education on the existing Thermoregulation at Delivery protocol and Delayed Cord Clamping guideline, and implementation of an improved workflow process, resulted in a reduction of hypothermia rates in infants delivered at 28 - 34 weeks gestation. Background • 10% of infants Nationally are born prematurely at less than 37 weeks gestation. 1% of infants in Utah are born prematurely between 28 and 34 weeks gestation • According to the World Health Organization (WHO) Globally, 60% of preterm infants are hypothermic on the first temperature after delivery • Hypothermia rates in Participating NICU’s and Delivery Centers occurs on average at a rate of 20% - 30% • Thermoregulation procedures established to prevent hypothermia are not used consistently in L&D units Results Fact Sheet Real-Time Reminder Cue Card Conclusions Methods • Compliance with the Thermoregulation at Delivery protocol was evaluated • Resuscitation records were reviewed to determine the incidence of hypothermia • Provider and staff education was developed and consisted of a fact sheet, references, and cue cards for shift huddles, staff meetings, and real-time visual reminders in the unit • A new workflow process for bowel bag usage at delivery was developed and implemented • Post-implementation hypothermia incidence change rates were assessed • Bowel bag usage compliance was absent in infants 2834 weeks • A retrospective review of pre-intervention resuscitation records show a hypothermia rate of 23% (n=10) • Overwhelmingly providers and staff recognized the lack of compliance with the protocol and guidelines specific to the existing Thermoregulation at Delivery and Delayed Cord Clamping protocols were provided • The delivery equipment set-up supplies were augmented with the bowel bag for all deliveries of infants 28-34 weeks and the usage of the bowel bag during deliveries increased to 75% (n=9) • Post-intervention review of resuscitation records showed a hypothermia rate of 8% (n=1) in infants born at 28-34 weeks Hypothermia Rates Pre and Post Intervention • Scheduled reviews of existing delivery protocols and guidelines are a best practice to ensure compliance and patient quality • Providers and staff recognized and cooperated to ensure the best care in compliance with the Thermoregulation at Delivery protocol and Delayed Cord Clamping guidelines • The need for re-education specific to new protocols and guidelines should be assessed • Provision of the bowel bag supply contributed to provider and staff compliance and usage • It is recommended that system-wide delivery units review their compliance with the Thermoregulation at Delivery and Delayed Cord Clamping guidelines for compliance. • It is recommended that the bowel bag is part of the standard set up for all deliveries on infants 28-34 weeks gestation COLLEGE OF NURSING