Achieving optimal cord management: a multidisciplinary quality improvement initiative

Area of Science:

• Neonatal care
• Clinical quality improvement
• Evidence-based practice

Background:

• Optimal cord management (OCM), delaying umbilical cord clamping for at least 60 seconds, is recommended for improved neonatal outcomes.
• Benchmarking data revealed low OCM rates (12.1%) in a tertiary neonatal unit, identifying a need for intervention.
• Existing literature supports OCM for both term and preterm infants.

Purpose of the Study:

• To implement and evaluate a quality improvement project (QIP) to increase OCM rates to at least 40% for infants born before 34 weeks gestation.
• To assess the sustainability of increased OCM rates.
• To monitor the impact of OCM on infant normothermia on admission.

Main Methods:

• A multidisciplinary team was formed, employing evidence-based quality improvement methodologies.
• The project focused on increasing OCM rates for infants <34 weeks gestation.
• Data on OCM rates and admission normothermia were collected and analyzed before and after the intervention.

Main Results:

• OCM rates for infants <34 weeks increased from 32.4% at baseline to 73.6% post-intervention.
• The improved OCM rates were sustained over a 9-month period, spanning two cohorts of rotational doctors.
• Admission normothermia rates remained stable (89.2% vs 88.5%) after the routine adoption of OCM.

Conclusions:

• A multidisciplinary, collaborative approach effectively increased OCM rates in a neonatal unit.
• National benchmarking data is crucial for identifying areas for quality improvement.
• The QIP demonstrated sustainable improvement in OCM practice without negatively impacting infant normothermia.