Implementation and Evaluation of a “Golden Hour” Protocol in a Level III Neonatal Intensive Care Unit

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Jurczyk, Amanda
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BACKGROUND: The neonatal “Golden Hour” is the first hour of life following premature birth. This timeframe greatly influences risk factors related to mortality and morbidity. Use of a golden hour protocol to guide evidence-based interventions helps to improve outcomes of prematurity.|PROBLEM: Premature infants are at a significantly increased risk for experiencing complications related to hypothermia, hypoglycemia, and respiratory failure. Implementation of a golden hour protocol has been shown to improve mortality rates and morbidities of premature infants by standardizing the approach to all interventions performed within the first hour of life.|PURPOSE: The purpose of this quality improvement project was to implement a golden hour protocol to be used in the NICU for premature infants born less than or equal to 33 0/7 weeks’ gestation.|SAMPLE and SETTING: The setting of this project was a level III NICU in the Denver metropolitan area. The participant sample included all inborn infants born less than or equal to 33 0/7 weeks’ gestation, excluding any precipitous deliveries, infants with congenital anomalies and deceased infants.|METHODS: A golden hour protocol was created to guide interventions for the birth of the intended population. Clinical outcomes were analyzed utilizing a retrospective chart review and post-implementation data collection. Outcomes measured included mean time to obtain vascular access, laboratory studies, initiate intravenous fluids, and mean admission axillary temperatures. Time of isolette top closure was included as a variable for post-implementation data only, due to lack of availability of retrospective data.|RESULTS: There were 15 infants in the pre implementation group and 8 infants in the post implementation group. Average gestational ages were similar for both groups. Improvements were seen in the post implementation group with decreased average time to obtain vascular access, obtain laboratory studies, and initiate intravenous fluids. The percentage of admission temperatures within a normal range were increased and average closure of isolette top was under one hour.|CONCLUSION: Implementation of a golden hour protocol resulted in improved outcomes for premature infants, consistent with the findings from previous golden hour protocol implementations, suggesting that continued sustainability of this project would be in conjunction with the standard of care and evidence-based practice for premature infants.
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