of Very Preterm Infants is Sustained in an Era of Increasing - PowerPoint PPT Presentation

Optimal Thermal Management of Very Preterm Infants is Sustained in an Era of Increasing Duration of Cord Clamping Angela Huang, BSN, RNC-Nic angela.huang@hhs.sccgov.org Quality and Data Nurse Coordinator Santa Clara Valley Medical Center May 26, 2017

Background • Public safety net hospital with a CCS regional level 3 NICU with approximately 400 admissions a year. • A standardized bundle approach in the delivery room, elimination of hypothermia (<36 0 C) (Manani et al 2013). San Jose

AIM To sustain our established optimal temperature management while increasing duration of DCC in very preterm infants (<32 weeks GA or ≤1500 grams) born between 2008-2017 Hypothermia (<36 0 C) • Suboptimal Thermal Management (<36.5 0 C) •

Methods: Our standardized thermoregulation bundle has included DCC since July 2007. 82% of VMC infants included in the CPQCC benchmark received DCC

Outcome Measure 1 Sustain 0% hypothermia rate (<36 ° C) 30s 60s 120s

Outcome Measure 2 Decrease our suboptimal thermal management rate (<36.5 ° C) from 21% in 2011 to less than 10% (Inborn) 60s 30s 120s

Balancing Measure: Hyperthermia rate (>37.5°C) 8% 2017 YTD: 0%

Balancing Measure: Survival without major morbidities (inborn)

DCC and Multiples DCC No DCC Total % DCC Di Di Twins 34 7 41 83% Mono-Di 47 8 55 85% Mono-Mono 3 1 4 75% Tri-Tri 12 0 12 100% Multiples 96 16 112 86%

Data Collection Customized in EMR OB Delivery Summary- evolved from static selection to continuous variable

Challenges/Lessons: 1. Standardization of practice with OB residents: • Continuous education • OB Grand Rounds 2. Communication with OB team • Review DCC goals before high-risk deliveries when possible • Abruption, ELBW, general anesthesia, multiples, anomalies • Reiteration and review outcomes with OB team 3. Monitor and review our processes and outcomes • Debriefing

Conclusions • Increased DCC duration from 30s to 2 minutes • No changes made to other thermoregulation processes • Sustained optimal admission temperature rate • Next step: focus on reducing hyperthermia.