Purpose for the Program
A trend of term newborns requiring transfer from the newborn nursery to the neonatal intensive care unit (NICU) was identified in a Level III NICU at a Magnet hospital. This offering will detail the pragmatic strategies utilized to decrease NICU admissions of high-risk transition newborns and present specific obstetric-related diagnoses.
To develop standards in clinical practice to promote newborn stabilization specific to newborns delivered between 35 and 36 weeks of gestation, born to mothers with chorioamnionitis or diabetes who received intravenous (IV) insulin during labor. Nurses are critical to assess, plan, act, and evaluate care for high-risk transition newborns to improve clinical outcomes and increase efficiency.
Implementation, Outcomes, and Evaluation
A collaborative team approach was taken to establish clinical criteria to identify infants at risk of transfer to the NICU. Standards were developed for newborns delivered between 35 and 36 weeks gestation, born to mothers with chorioamnionitis or diabetes who received IV insulin during labor. These infants, high-risk transition newborns, are admitted to the NICU for up to 6 hours of observation. Glucose management, breastfeeding, and newborn admission policies were revised to reflect new processes. The criteria and interventions were standardized and embedded into practice. A multidisciplinary approach was utilized to assure all care providers involved with maternal–newborn care received education, including process flow charts, algorithms, and reference cards. The criteria were communicated to the family prior to delivery to ensure inclusion with all aspects of care. To foster family-centered care, families were made aware of where their newborns would be admitted. Since July 2008, full-term hypoglycemic newborn transfers decreased 15% from the mother–baby unit to the NICU, the admission of high-risk transition newborns to the NICU increased 27%, and the transfer of all newborns back to the mother–baby unit is about 80%.
Implications for Nursing Practice
Clinical criteria to identify newborns at risk of instability during extrauterine transition of life were standardized and embedded into practice. These criteria provided necessary collaborative nursing and medical management of the newborn patient care for the newborn nursery registered nurse and the primary care pediatrician. Clinical autonomy was maintained for the NICU nurse who provided care to the newborn during the transitional time frame. Standard processes and care requirements enabled nurses in a NICU to make prudent and timely decisions to improve neonatal outcomes. Improved quality outcomes for the newborn and improved patient satisfaction are a direct result of a standardized plan of care for high-risk transition newborns.