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Golden Hour Protocol for Preterm Infants: A Quality Improvement Project
Tiffany L Harriman1, Brigit Carter, Robin B Dail
1Duke University School of Nursing, Durham, North Carolina (Drs Harriman and Carter); College of Nursing, University of South Carolina, Columbia (Dr Dail); and Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Stowell).
Summary
The Golden Hour protocol, designed for preterm infants, showed clinical improvements in temperature, IV fluid, and antibiotic administration times. Successful implementation requires staff education and stakeholder involvement for better infant outcomes.
Area of Science:
- Neonatal care
- Pediatric intensive care
- Evidence-based practice
Background:
- Preterm infants face significant risks including hypothermia, hypoglycemia, and sepsis in the early hours of life.
- A structured "Golden Hour" protocol can mitigate these risks and improve outcomes for premature neonates.
- Military care facilities can benefit from standardized protocols for vulnerable preterm populations.
Purpose of the Study:
- To assess the impact of a Golden Hour protocol on the admission process for infants born before 32 weeks' gestation.
- Key objectives included evaluating infant temperature, timing of IV fluids and antibiotics, and incubator closure.
- The study aimed to determine the protocol's effectiveness in a military healthcare setting.
Main Methods:
- A pre-/postimplementation design was employed to compare outcomes before and after protocol adoption.
- Data collection involved electronic health record review for preimplementation metrics.
- Neonatal Intensive Care Unit admission worksheets were used for postimplementation data collection.
Main Results:
- While not statistically significant, postimplementation showed a trend towards more infants achieving a temperature >36.5°C within one hour.
- Clinically significant decreases were observed in the time to initiate IV fluids and administer antibiotics.
- The time to close the incubator top remained longer than the targeted one hour.
Conclusions:
- Implementing a Golden Hour protocol offers a structured approach to enhance the care of preterm infants during their critical first hour.
- Successful protocol implementation hinges on the engagement of key stakeholders and comprehensive staff education.
- Further research into long-term outcomes and potential barriers is recommended for refining such protocols.
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