Neonatal Quality Improvement
Neonatal Quality Improvement 6
Chandana Ravikumar, DO (she/her/hers)
NPM Fellow
McGovern Medical School at the University of Texas Health Science Center at Houston
Houston, Texas, United States
The 8th edition Neonatal Resuscitation Program (NRP) recommends establishing a plan for umbilical cord management before infant delivery. NRP, the American College of Obstetrics and Gynecology (ACOG), and the American Academy of Pediatrics (AAP) recommend 30-60 seconds of delayed cord clamping (DCC) for vigorous infants. Evidence supports that DCC has favorable outcomes in term and preterm newborns. The timing of clamping the umbilical cord currently varies amongst obstetrical (OB) teams at Children’s Memorial Hermann Hospital (CMHH). Additionally, there is inconsistent documentation of clamping data in the delivery record.
Objective:
3 SMART (Specific-Measurable-Attainable,Realistic, Time-bound) aims were developed. Achieve DCC in 60% of all vigorous infants at CMHH by December 2022. Achieve 80% compliance with DCC documentation by December 2022. Achieve DCC in 40% of vigorous preterm infants by December 2022.
Design/Methods:
QI methodology was used to develop this initiative. Pre-intervention efforts focused on stakeholder buy-in and education. 3 Plan-Do-Study-Act (PDSA) cycles were implemented during February 2022 to November 2022. A DCC plan pre-birth question was added to an existing NICU/L&D communication tool in February 2022. A DCC protocol was implemented in April 2022. A DCC survey was given to the NICU staff in July 2022 to assess knowledge of pre-birth questions and evaluate DCC barriers. As a result of this survey, Neonatal Nurse Practitioner (NNP) and OB champions were identified in September 2022. The NNP and OB champions provided DCC education to respective groups. Additionally, a scripted communication tool was developed with the plan to implement it in January 2023.
Results:
No baseline DCC data was available for all infants due to lack of documentation. A total of 337 inborn infants of all gestational ages were surveyed from February 2022 to November 2022. A median of 49% (range 26%-61%) of all infants received DCC. The average duration of DCC for infants who received DCC was 44 seconds. A median of 65% of all infants had a DCC plan documented. A median of 41% (range 20%-83%) of preterm infants (< 37 weeks gestational age) received DCC.
Conclusion(s):
After implementing 3 PDSA cycles, our group accomplished improved rates of DCC documentation and infants receiving DCC. Future directions include a scripted communication tool to achieve our SMART aims and consistent improvement in DCC rates. Efforts are being developed around sustainability. .png)
