653 - Improving early postnatal care of newborns at risk for hypoglycemia.

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 653
Publication Number: 653.138

Kelechi Ikeri, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Anna Bozeman, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Vicki C. Curtis, USA Children's & Women's Hospital, Mobile, AL, United States; Teneshia Edwards, USA Children's and Women's Hospital, Mobile, AL, United States; Claudia M. Reed, University of South Alabama Children's and Women's Hospital, Semmes, AL, United States; Elizabeth L. Turnipseed, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Michael Zayek, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States

Presenting Author(s)

KI

Kelechi Ikeri, MD

Adjunct Assistant Professor
University of South Alabama Children's and Women's Hospital
Mobile, Alabama, United States

Background:

Neonatal hypoglycemia can result in brain injury therefore, at-risk newborns require careful clinical surveillance which should be initiated soon after birth. Of the newborn nursery admissions in our center, the percentage of asymptomatic at-risk newborns receiving point-of-care glucose screenings performed by 2hours of age (best practice guidelines) was only 41 %.

Objective:

To increase from 41% to >80%, the rates of at-risk well-appearing late preterm and term newborns receiving glucose screenings in the first 2hours of life by February 2023.

Design/Methods:

This initiative was conducted in the Labor and Delivery unit of a regional academic hospital (2500 deliveries per year). Baseline data from January 2022-July 2022 were reviewed. Our interdisciplinary quality improvement team investigated barriers to timely identification of at-risk status and factors contributing to screening delays. Key drivers were identified (Fig 1). We implemented the following measures starting August 2022: clinical care policy formulation with delivery care nursing (DCN) role clarification, DCN recruitment and education, growth chart signage in the delivery room and newborn nursery and timely staff feedback. Plan-Do-Study-Act (PDSA) model for improvement was used. Outcome measures were the percentage of at-risk newborns screened within 2hrs of life (depicted on a P-chart. Fig 2) and the average time to first postnatal glucose screening (displayed on an X-bar S chart. Fig 3). Process measures proven to improve glycemic control such as skin-to-skin (STS) care and breastfeeding initiation were analyzed pre- and post-intervention. Balancing measure was STS care complications such as falls and suffocation.

Results:

Baseline and preliminary improvement data were collected for a total of 2020 newborns from January to December 2022 of which 25% were at risk for hypoglycemia. Among these at-risk newborns, the percentage of newborns screened within 2hrs of life increased from 41% to 73% while the mean time to first postnatal glucose screening decreased from 166mins to 108mins (35% reduction). Special cause variation was observed in both measures. STS rates increased from 58 % to 67 %, p< 0.05, and breastfeeding initiation rates increased from 37 % to 43 %, p< 0.05. There were no adverse events reported during skin-to-skin care.

Conclusion(s):

Expansion of the DCN program coupled with continued provider education and feedback improved hypoglycemia surveillance, STS and breastfeeding initiation rates without increasing related adverse events. Efforts towards further improvements continue.