The Regional Medical Center at Memphis was recognized at the 11th Annual Quality Congress during Vermont Oxford Network’s annual meeting for a quality project in the Newborn Center. The project led to sustained improvements related to thermoregulation.
“Research shows that cold stress can affect infant morbidity and increase the risk of death, which is particularly a concern for the very low birth weight infant,” said Kelley Smith, Nurse Manager in the Newborn Center. “We felt that thermoregulation from the point of delivery to admission in our NICU was an area we could improve upon and dramatically impact successful outcomes.”
The Regional Medical Center is a member of the Vermont Oxford Network, a network including more than 850 NICUs around the world. As a member of the network, the Newborn Center participated in a 2-year quality improvement collaborative on Infant Resuscitation and Stabilization from January 2009 to December 2010. Being part of the collaborative allows hospital staff the opportunity to undertake quality initiative projects and learn from and share data with other network hospitals. The Newborn Center’s project focused on Infant Resuscitation and Stabilization, one of the eight areas of focus included in each collaborative.
The collaborative team included nurses, physicians and other Newborn Center and Labor and Delivery staff. According to Smith, the team looked at processes in place from the delivery room to the unit and established best practices from other hospitals to find areas for improvement in the process. Several opportunities for improvement emerged. For example, babies were being weighed in Labor and Delivery on cold scales, bringing down their temperature and therefore making them too cold upon arrival in the NICU. Beds with built in scales in Labor and Delivery along with warming mattresses used in transport now combat this problem.
The goal temperature for an infant upon admission to the unit is between 36 and 37.5 degrees Celsius. Data from 2006 and 2007 shows that between 40 and 45 percent of babies transported to the NICU were in the target temperature range upon admission. During the second quarter of 2009, at a time when new processes were just beginning, the number of infants in the target temperature range rose to 55 percent. Today, the number is now up to 95 percent.
“We were asked to present at the Quality Congress because of the drastic improvements we made during these past 2 years and also because we’ve shown a strong level of sustainability of the improvement,” said Smith.
In addition to the thermoregulation project, the team worked on two other quality initiatives as part of the collaborative. A checklist was created for use in Labor and Delivery that is completed before deliveries of any “high risk” moms whose infants are potential Newborn Center admissions. Another project was related to the delivery of rescue surfactant to the lungs in very low birth weight infants in respiratory distress.