Hardwiring Excellent Outcomes for Late Preterm Infants

The dilemma of the near term, or late preterm, infant (NTI) impacts the Perinatal, Women and Children’s departments of our hospital on a daily basis. The incidence of births of NTI’s at our facility is similar to the national averages, 6-8% of birth. The majority of these infants go the postpartum Family Centered Care (FCC) Unit with the mother. The needs of these infants related to the increased acuity has created challenges for all of our staff.

Our health system is incorporating the concepts of Quint Studer’s Hardwiring Excellence into our daily practice. Hardwiring means that designated practices are ingrained into what staff members do. The goal is that by hardwiring these practices we can achieve excellent outcomes for our patients. Managing NTI’s by these principles seemed like a natural progression in our journey.

In mid-2006, the management team of the department decided that we would implement a specific education plan for families of NTI’s. In order to accomplish this, the staff needed to be at a baseline level of education and we needed content for the staff and family education. We used the AWHONN CD-ROM on the Near Term Infant for this. Our plan was to obtain physician support, develop and implement an education program for staff, educate the community physicians about the program and initiate the family education.

Our medical and nursing staff reviewed the patient handout created by AWHONN. They requested some minor wording changes. We requested and obtained permission from AWHONN to make the changes and cite this on our handout.

The management team felt this was important enough to make it a required educational competency for staff on all units – Labor and Delivery, FCC, NICU and Pediatrics. A computer-assisted learning program was developed for our education portal and required that staff successfully complete a post-test to demonstrate learning. The education program was implemented in January 2007 and by the end of March more than 80% of staff had completed it. We set a target day of May 1 to begin the family education.

During April we reviewed the upcoming program with staff and spoke one-on-one to community pediatricians. We provided both groups with copies of the handout for the families so they would be familiar with the content. We asked nurses to begin to include that an infant was near term in their unit-to-unit and shift-to-shift reports. We identified a process in which the labor nurse placed the information that an infant is near term in the recorded patient history, the nurse admitting a NTI to FCC or NICU would provide the handout to the family. If a NTI who was not born at our hospital is admitted to the Pediatric unit, they will provide a handout as well. If the infant was born in our facility, they review pertinent education.

Staff feedback has been very positive, as they begin to hardwire this practice. We are currently monitoring to determine if this education program might decrease readmission of NTI’s to the hospital after discharge.