MWH NICU Golden Hour
Suzie Paradis RNC-NIC, MWH Neonatal Intensive Care Unit
The NICU looked at the mortality rate in the United States of Very Low
Birth Weight (VLBW) neonates (Infants 28 weeks or less gestation) and
found it was 14.6%. (1) This population of patients has a high incidence
of co-morbidities due to sepsis, intraventricular hemorrhage, necrotizing
enterocolitis, retinopathy of prematurity and chronic lung disease. The
transition to extrauterine life in the first hour after birth are critical
for these patients and standardization of this care has the potential
to improve quality of life and decrease the co- morbidities for these infants.
The goal of the project was to improve outcomes to the VLBW population
and family satisfaction, build an interdisciplinary team, create a seamless
new practice and potentially to decrease length of stay. The group reviewed
the literature to determine optimal management interventions which focused
on thermal, respiratory and nutritional management of the neonate, performed
chart reviews for baseline Pre Golden Hour data, identified key team participants,
and reviewed previous practice.
The departments involved in the project included NICU RNs, Labor and Delivery
RNs, Respiratory Therapists, Neonatal Nurse Practitioners, Neonatologists,
Pharmacist, Biomedical Engineers and Nursing Leadership. After the literature
review was presented, the group developed tracking documentation forms;
Golden Hour giraffe bed contents, reviewed key roles of participants,
adapted giraffe bed to Golden hour bed and NICU admission medications
were all placed in one Acudose drawer.
Some of the identified barriers were distance of x-ray staff and equipment
and resistance of team members to attempt Peripheral IV and lack of technology
for finding IV access. Our next steps are to mitigate those barriers by
obtaining a xray reader in NICU and work with radiology to have staff
more readily available Accuvein Machine for NICU and encourage peripheral
The following graph demonstrates the progress the team made in each segment
of the golden hour care.
Performance Improvement Plan