“HAVE CARE – WILL TRAVEL WITH BABY”

Patient Safety: Newborn Stabilization and Communication across Units of Service

Purpose:
In an environment in which Family Centered Care is practiced and the newborn infant is kept with the mother and family there was a need to evaluate the care and documentation for the newborn during transition and transfer from one nursing unit to another.  A core measure was Newborn Stabilization, which focused on the newborn during the transition period after birth.  Criteria for assessment and practice were established and audited for outcomes. Two out of the 4 criteria identified were constantly found to be within defined limits at 97 – 100% compliance. However, the two other criteria consistently fell below the fifty percentile.                          

Project:
A group composed of staff RNs serving on the practice councils from all 3 maternal/child nursing units caring for the newborn was formed to evaluate the two criteria which consistantly were low.  The purpose was to have staff driven governance that would evaluate current research, define best practice and refine documentation and practice policies in caring for the newborn. Based on the group’s findings, utilizing literature, AWHONN standards of practice and best practice guidelines it became apparent there was a need to develop a different documentation tool.  Four different paper forms were discarded and combined into one Newborn Flow Sheet.  This provided a means of documentation for all infant assessments and care which flowed with the infant during the transition period regardless of where they were physically located in the department.  The result was a continuous record that was immediately available for all providers of care.
New policies for Hypoglycemia and Newborn Assessment were developed based upon the current Standards of Care. A colorful algorithm which aids staff in following the appropriate path for each infant’s glucose protocol was developed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
Outcome:
This staff driven project led to a change in policies, practice and documentation, that ensured that all babies were being appropriately assessed and monitored during this critical transition period.  Audits of the flow sheet have shown great improvement in identifying hypoglycemic infants (greater than the 96^th percentile) and that all staff, in every nursing unit are practicing consistent, evidenced based assessment of the newborn during transition period.