The Great Pretenders: Utilizing Evidence-Based Practice to Optimize Clinical Outcomes for the Late Preterm Infant

Authors


Paper Presentation

Purpose for the Program

The late preterm infant faces many challenges associated with prematurity. In 2010, 99 late preterm infants (approximately 5% of the total birth volume) were born at Peninsula Regional Medical Center. Nearly 29% of these infants were admitted to the neonatal intensive care unit (NICU), and 12.8% were readmitted to the pediatric unit for complications associated with prematurity. The purpose of this program was to determine if adopting an evidence-based model of care utilizing the Association of Women's Health, Obstetric and Neonatal Nurses’ Assessment and Care of the Late Preterm Infant Guideline will improve clinical outcomes and reduce late preterm infant neonatal intensive care unit admissions and readmissions to the pediatric unit.

Proposed Change

To adopt, institute, and practice Association of Women's Health, Obstetric and Neonatal Nurses' (AWHONN) clinical guidelines for every infant born between 34.0 and 36.6 weeks of gestation at Peninsula Regional Medical Center.

Implementation, Outcomes, and Evaluation

Data collection took place over a 6-month period to determine baseline rates of hypothermia, hypoglycemia, respiratory distress, feeding difficulties, phototherapy, excessive weight loss, neonatal intensive care unit admissions, and readmissions to the pediatric unit. A multidisciplinary team developed the late preterm infant initiative utilizing AWHONN's clinical guidelines. Components of the initiative included policy and order set development, predelivery and predischarge education, and individualized feeding plans. Beginning March 22, 2011, all late preterm infants were admitted to the intermediate care nursery and cared for with a nurse-to-patient ratio of 1:3 to 4. All aspects of the clinical guidelines were utilized based on the individual needs of the infant. Data collection on these infants began May 1, 2011.

To date, 31 late preterm infants have been cared for under the new initiative. Eight of these infants were subsequently admitted to the neonatal intensive care unit (25.8%), and no infants were readmitted to the pediatric unit. The overall goal is to improve clinical outcomes while reducing admissions to the neonatal intensive care unit by 10% and readmissions to the pediatric unit by 5%, as compared with the 2010 rates.

Implications for Nursing Practice

As the primary bedside caregiver, nurses are extremely vested in their patients’ outcomes. This initiative has led to an increased staff awareness of this population, their unique needs, and the challenges they face. This knowledge, coupled with the utilization of evidence-based care, translates into improved clinical outcomes for the late preterm infant. This initiative also has improved teamwork and communication and has fostered relationships between nurses and other health professionals. Family-centered care is at the core of obstetric nursing as well as this initiative. Providing care that enhances family bonding, empowers parents, and improves clinical outcomes increases patient and nurse satisfaction. In this era of rising health care costs and nonreimbursement for preventable readmissions, it behooves nurses to adopt practices that anticipate and prevent possible sequelae related to late prematurity.

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