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First Golden Hour of Life: A Quality Improvement Initiative
Tinisha M Lambeth1, Mario A Rojas, Amy P Holmes
1Wake Forest University School of Medicine, Winston-Salem, North Carolina (Drs Lambeth and Rojas); Novant Health Forsyth Medical Center, Winston-Salem, North Carolina (Drs Lambeth, Rojas, and Holmes); and Duke University School of Nursing and School of Medicine, Durham, North Carolina (Dr Dail).
Insights
An evidence-based golden hour protocol (GHP) improved care efficiency for very low birth-weight infants. The GHP stabilized vulnerable newborns within the first hour, decreasing time to critical interventions like IV fluids and antibiotics.
Area of Science:
- Neonatal Intensive Care
- Quality Improvement Science
- Pediatric Medicine
Background:
- Very low birth-weight infants (<1500 g) require specialized care due to environmental vulnerability in the first hour post-birth.
- A level IIIB neonatal intensive care unit (NICU) developed an evidence-based golden hour protocol (GHP).
- The GHP aimed to stabilize infants and complete admission procedures within 60 minutes of birth.
Purpose of the Study:
- To evaluate the effectiveness of an evidence-based GHP in enhancing care efficiency.
- To determine if the GHP positively impacts short-term outcomes for vulnerable newborns.
- To assess the impact of a structured protocol on neonatal admission processes.
Main Methods:
- Quality improvement project utilizing rapid cycles of Plan-Do-Study-Act (PDSA).
- Statistical process control (SPC) methods were employed to monitor and analyze process measures over time.
- Key performance indicators included admission temperature, glucose levels, and time to interventions.
Main Results:
- Admission temperature and glucose levels remained within reference ranges, indicating process stability.
- Significant reductions were observed in the time to initiate intravenous fluids and antibiotics.
- A positive trend was noted for surfactant administration within the initial 2 hours of life.
Conclusions:
- The GHP facilitated an organized approach to neonatal admission and care delivery.
- Checklists and timed interventions increased NICU caregiver awareness of time management.
- The protocol successfully decreased the time to critical interventions, improving initial care for high-risk neonates.
Background:
Very low birth-weight (<1500 g) infants are vulnerable to their environment during the first hour after birth. We designed an evidence-based golden hour protocol (GHP) with a goal to stabilize and perform admission procedures within 1 hour of birth at a level IIIB neonatal intensive care unit (NICU).
Purpose:
The aim of this quality improvement project was to ascertain whether an evidence-based GHP would improve care efficiency and short-term outcomes.
Methods:
Rapid cycles of change using Plan Do Study Act were utilized to document progress and gain knowledge during the quality improvement project. Measures were plotted with statistical process control methods (SPC), which analyzed improvement over time.
Results:
Both admission temperature and glucose-level means were within reference range throughout the project and predicted a stable process. We observed significantly decreased time to initiation of intravenous fluids and antibiotics. An upward trend of surfactant administration within the first 2 hours of life was also observed.
Implications For Practice:
The use of a GHP provided an organized approach to admission procedures and care. By using a checklist and recording intervention times, NICU caregivers were more aware of time management for each intervention and were able to decrease time to initiation of intravenous fluids and antibiotics.
Implications For Research:
Future research should focus on establishing normal blood pressure ranges and safe pain management during the "golden hour" and beyond. Future quality improvement should focus on improving subsequent temperature and blood glucose levels after admission umbilical artery and venous catheter placement.
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