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Abstract
Background Nationwide Children's Hospital NICU at The Ohio State University Wexner Medical Center has 4500 deliveries per year and 800 beds. The NICU is a LEVEL III Unit with 49 beds and 1200 admissions. On average 100 <28 week admissions.
Objectives Improve rates of golden hour stabilization at 135 minutes of life from 17% to 80% by 1/31/2017 and sustain these rates indefinitely. We define complete stabilization as achieving and maintaining neutral thermal environment (NTE), rapid treatment of presumed sepsis, and prevention of hypoglycemia with timely IV glucose and protein administration
Methods Our multidisciplinary Golden Hour QI Team was formed October 2014 and through the process mapping timeline and pareto chart we found our key drivers. Using the principles of a fish diagram for each driver we were able to highlight interventions. As we did our PDSA cycles we realized our focus was providing support to personnel resulting in increased efficiency and communication. Our interventions are listed in the discipline-specific bundled approach we implemented them.
Results We decreased our times to NTE, IVF and antibiotics administration surpassing our goals as shown in our control charts. Our timeline bundle compliance has been increasing steadily from 88% to 95%. We have found no change in our mortality rates of less than 20%.
Conclusions Next PDSA cycle is transferring administering IVF and Ampicillin to the physician/NNP placing the lines eliminating the need for nursing to become sterile again. We are also implementing a count-down timer as used in trauma medicine as a data tool to the resuscitation team.⇓⇓⇓⇓⇓
Drivers.
- Accreditation
- Anaesthesia
- Attitudes