Implementation of a Small Baby Team to Improve Outcomes for Infants Less than 30 Weeks of Gestation
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Background: Although extremely low gestational age infants continue to have improved rates of survival, they have the greatest risk of morbidities for infants born prematurely. These infants also incur the greatest cost of Neonatal Intensive Care Unit (NICU) patients. It has been demonstrated that standardized care practices along with a team approach to care improves outcomes for these infants.|Problem: There are no consistent standards for the admission and management of infants less than 30 weeks of gestation. Practices varied among providers. Knowledge levels of nurses vary, resulting in variations in care provision.|Purpose: The purpose of this quality improvement project was to implement a Small Baby Team approach with standardized education, to improve outcomes in a level III NICU.|Sample and Setting: The project was conducted in a 34-bed level III NICU in an urban hospital with an average of 60 extremely low gestational age infants born each year.|Methods: A prospective, quality improvement project was conducted from October 2018 until January 2020. Patient data was collected before and after the implementation of standardized education, standardized admission process, and initial team formation. Multiple Plan-Do-Study-Act cycles were conducted throughout the time period to improve the delivery room and admission processes.|Results: There was improvement in all Golden Hour time measurements. Overall rates of intraventricular hemorrhage increased slightly, with no change in BPD rates and a decrease in ROP rates. Staff member confidence in caring for small babies after education increased from 36.4% completely confident to 84.4% completely confident.|Discussion/ Implications: A focused, in-depth education program improves the confidence of staff members in caring for this unique population. The combination of education and simulation training led to improved Golden Hour adherence and outcomes. Continued staff education, standardization of care, and consistent team practices will continue to drive this improvement process.
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