Program Development and Implementation of an Evidenced-Based Guideline for the Management of the Extremely Premature Infant in the First Seventy-Two Hours of Life
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Authors
Tinling, Megan
Bosque, Elena
Issue Date
2019-04-27
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Abstract
Background: Advancements in medicine allow extremely preterm infants to survive, but not without potential adverse sequelae. Development and implementation of a guideline standardizing care for the first 72 hours of life has been suggested to improve outcomes.|Purpose: To measure knowledge and compliance after program development and implementation of an evidence-based standardized care guideline for the first 72 hours for infants born less than or equal to 28 weeks’ gestation.|Methods/Search Strategy: Staff training and testing on care of the extremely preterm infant was completed. A checklist and audit tool was developed to evaluate compliance. A bedside card to guide family participation was created.|Findings: An increase in knowledge was demonstrated through an average pre-test score of 63% compared to post-test average scores of 86%. Fourteen infants were born following implementation who received care per guidelines. The audit tool completion varied from zero to 100%, leading to evaluation of barriers and steps identified to improve compliance. Multiple factors influenced the ability to have a hands-off approach during the initial 72 hours, including interventions and procedures. All fourteen of the infants received oral immune therapy and twelve infants had the family bedside card present.|Implications for practice: Implementation of an evidence-based guideline to support a standardized approach for the care of the extremely preterm infant for the first 72 hours is feasible and supportive of optimal outcomes. Involvement of key stakeholders, interdisciplinary staff education, and use of a checklist audit tool, to ensure compliance, are critical elements for successful implementation.|Implications for research: In an adequately powered randomized control trial future research may include evaluation of rates of key outcome indicators such as IVH, NEC, ROP, infection and mortality. An evidenced-based process should be implemented to encourage and support family integrated care.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University