Implementing Evidence-Based Policies for the Late Preterm Infant in a Large Tertiary Facility

Brigham and Women’s Hospital is a large tertiary facility in Boston, Massachusetts that accommodates 8,500 deliveries per year. In the course of a year there are approximately 525 Late Preterm Infants admitted to the newborn nurseries. CWN 10, one of 3 postpartum/nursery units, has 30 postpartum beds and a normal newborn nursery. The nursery admits newborns from 35 weeks gestation to term. The CWN 10 nurses are a seasoned staff with low turnover.

This initiative was proposed by a group of staff nurses on CWN 10 who were concerned that the special needs of the Late Preterm Infant were not being met, even though there was a policy in place for the newborn who is less than 37 weeks gestation. The two main concerns were staff/family lack of knowledge about the risks and care associated with being Late Preterm and also a failure in the system to provide easy recognition of these infants who were mixed in with the general nursery population of term infants.

The goal of the project was to develop policies that would enable staff throughout the CWN division to more efficiently and consistently meet the needs of the Late Preterm Infant. Implementation has been an evolving process. Here are the steps involved in the process to date:

1. Identify a core group of nurses to serve as a steering committee for the initiative.
2. Discuss the deficits in the current system of care for Late Preterm Infants.
3. Identify strategies for overcoming staff resistance to policy change.
4. Discuss how to elicit cooperation and input from the other units in the division.
5. Enlist the support of pediatricians, obstetricians and midwives.
6. Decide on practice changes that would educate families.
7. Develop a method for instant sight recognition of Late Preterm Infants.
8. Provide resources for ongoing staff education.
9. Use other division initiatives to complement and enhance care of the Late Preterm Infant.
10. Constantly disseminate information about the project to the division and the hospital.
11. Obtain funding for a clinical research study about staff and patient satisfaction related to the “interactive bath”.
12. Publish a journal article about the project.
13. Present at the 2008 AWHONN convention!

Evaluation of the project is multifaceted and ongoing. As the project evolves, we will create the mechanisms needed to evaluate the success of the project.

Evaluation methods already in place:

1. Awareness about the special needs of the Late Preterm Infant has risen as evidenced by the topic regularly appearing on division committee agendas. (This was not the case 2 years ago.)
2. Tracking usage of the parent education folders.
3. Audits of colored crib card use on cribs of Late Preterm Infants.
4. Surveys of staff to assess level of knowledge about Late Preterm Infants, policies regarding care of Late Preterm Infants and parent education about Late Preterm Infants.