Thermoregulation Management and Documentation During the First 12 Hours of Life for Low Birth Weight Infants: A Quality Improvement Practice Change

Abstract

Purpose: The purpose of this project was to explore how implementing a temperature monitoring data sheet would improve consistency in thermoregulation monitoring and management by nurses.|Background: An issue with preterm infants is thermoregulation. Decreasing the incidence of hypothermia will increase survival, as well as survival without morbidity for VLBW infants. At this NICU there is a concern that documentation is inconsistent; measurements provided for thermoregulation and monitoring of temperatures lacks consistency. Education on the importance of thermoregulation and documentation for all RNs would improve compliance and knowledge. Improved thermoregulation monitoring and recording may decrease euthermia, as admission would not be delayed for improved temperatures.|Sample/Setting: The setting was a western coast level IV NICU level NICU. The sample included all newborns delivered at this hospital that weighed <1501 grams. Exclusion criteria included infants transported from a referral center.|Methods: The design of this study was based upon the IOWA model. It encompassed a quality improvement practice change requiring nurses to complete a thermoregulation data sheet improving monitoring and maintenance for euthermia. Data was compiled, analyzed, and compared to historical trends within the unit.|Results: Pre-implementation mean admission temperatures were 36.7⁰C; 70% of infants were euthermic upon admission, 23% were hypothermic, and 7% were hyperthermic. Post-Implementation mean admission temperatures were 36.9⁰C; 80 % were euthermic upon admission, 15% were hypothermic, and 5% were hyperthermic. Thermoregulation measures were tracked was shown to be trending toward an increase in compliance.|Conclusion: Implementation of the thermoregulation data sheet practice changes have increased staffs awareness of the importance of thermoregulation monitoring and management. Increased compliance has occurred as has improved euthermia rates. Towards the end of the project data sheets were not being utilized, the IOWA model was implemented to reinforce consistency. Further improvement with compliance of thermoregulation measurements and euthermia rates is anticipated.