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Sunday, June 28, 2009
Hall A (San Diego Convention Center)
Implementation of a Car Seat Challenge Program for the Late Preterm Infant on a Postpartum Unit
In 2005, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) identified an opportunity to improve care to infants born between the ages of 34 and 36 6/7 weeks gestation. AWHONN developed the late pre-term infant initiative program to establish guidelines for the care for these infants.
The National Center for Health Statistics data showed that the late pre-term infant comprised 8.5% of all births in the US in 2002 (AWHONN,2006). In the same year the mortality rate for this group was 9.2 per 100,000 live births. When compared to the 2.5 per 100,000 live births in full term infants, born that same year, it is easy to see the increased potential for risk in this group (AWHONN, 2006). In 2006, 8% of all births at Christiana Care Health System (CCHS) involved late pre-term term infants. This group is at increased risk for complications and requires more frequent assessments and individualized plans of care.
In 1996, the American Academy of Pediatrics issued a statement that certain late preterm infants (those less than thirty seven weeks) when placed in a car seat were more prone to a decrease in heart rate, pulse oxygenation, and respiratory rate. This policy statement recommended facilities caring for late pre-term infants implement a program to provide testing prior to discharge. Postpartum nursing staff at CCHS made a commitment to improve the standard of care for their patient population and implemented car seat challenge testing on the postpartum units.
A select group of postpartum nurses stepped up to this challenge. Monitors were purchased and education provided to the nursing staff in the use of the new equipment. In collaboration with occupational therapists and parent education staff, nurses learned about different types of car seats, proper positioning, testing procedure, parameters for passing and documentation of the procedure. Guidelines were established to outline care of those infants who failed the challenge test. These nurses also educated parents on infant placement in the car seat to assure their safety. The program was implemented in July 2007 to provide testing to all pre-term infants cared for on postpartum units.
Nurses have maintained a log of all late pre-term infants who have been tested prior to discharge. As ofJune 17, 2008 we have tested 349 infants. Results have found some seats to be expired on inspection, seats too large for the late pre-term infant, improper strap placement and infants experiencing a decrease in heart rate and pulse oxygenation causing the test to be stopped.
The significance of the above findings has greatly improved the standard of care for late pre-term infants by meeting the recommendations of AWHONN and AAP. All late pre-term infants cared for at CCHS now receive a car seat challenge test as part of their discharge planning.
In 2005, the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) identified an opportunity to improve care to infants born between the ages of 34 and 36 6/7 weeks gestation. AWHONN developed the late pre-term infant initiative program to establish guidelines for the care for these infants.
The National Center for Health Statistics data showed that the late pre-term infant comprised 8.5% of all births in the US in 2002 (AWHONN,2006). In the same year the mortality rate for this group was 9.2 per 100,000 live births. When compared to the 2.5 per 100,000 live births in full term infants, born that same year, it is easy to see the increased potential for risk in this group (AWHONN, 2006). In 2006, 8% of all births at Christiana Care Health System (CCHS) involved late pre-term term infants. This group is at increased risk for complications and requires more frequent assessments and individualized plans of care.
In 1996, the American Academy of Pediatrics issued a statement that certain late preterm infants (those less than thirty seven weeks) when placed in a car seat were more prone to a decrease in heart rate, pulse oxygenation, and respiratory rate. This policy statement recommended facilities caring for late pre-term infants implement a program to provide testing prior to discharge. Postpartum nursing staff at CCHS made a commitment to improve the standard of care for their patient population and implemented car seat challenge testing on the postpartum units.
A select group of postpartum nurses stepped up to this challenge. Monitors were purchased and education provided to the nursing staff in the use of the new equipment. In collaboration with occupational therapists and parent education staff, nurses learned about different types of car seats, proper positioning, testing procedure, parameters for passing and documentation of the procedure. Guidelines were established to outline care of those infants who failed the challenge test. These nurses also educated parents on infant placement in the car seat to assure their safety. The program was implemented in July 2007 to provide testing to all pre-term infants cared for on postpartum units.
Nurses have maintained a log of all late pre-term infants who have been tested prior to discharge. As of
The significance of the above findings has greatly improved the standard of care for late pre-term infants by meeting the recommendations of AWHONN and AAP. All late pre-term infants cared for at CCHS now receive a car seat challenge test as part of their discharge planning.
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