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In 2005, the Association of Women’s Health, Obstetric, and Neonatal Nurses ( AWHONN) launched an initiative to address the unique physiological and developmental needs of late preterm infants born between 34 and 37 weeks gestation.  The standards for care focused on neonatal functional status, nursing care practices, care environment, and the role of the family in the hospital and after discharge.  Prematurity is one of the most significant threats to infants.  Late preterm infants may appear to be smaller versions of  term infants; however,   they are at high risk for problems related to immaturity of each body system, thermoregulation, hypoglycemia, jaundice and feeding issues.  Prematurity may negatively impact on outcomes, provide challenges to the family and result in increased costs to both the parents and the organization.

Our   599  bed community health system offers both perinataology services and a level III NICU.  Of  the 4,500 infants born at our hospital each year, approximately 500 are late-preterm infants.  Most of these infants receive care in our newborn nursery.  The need to effectively implement the AWHONN recommendations to improve care and outcomes for the vulnerable late preterm population became an organizational priority.

Studies have shown the length of time for research to be translated into practice ranges from 17 to 24 years. The application of an evidence-based practice model, The Iowa Model of Evidence Based Practice to Promote Quality Care, was used to guide our implementation of standards of care and changes in practice to address the unique physiological and developmental needs of vulnerable late preterm infants.  A review of the literature and our current standards of care indicated that sufficient research base for practice change existed. The implementation of evidence-based  practice occurred over a 4 year period rather than the typical time frame described in the literature.

The implementation of evidence-based practice changes was a collaborative approach that included nursing, medicine, respiratory therapy, and social work.    Lead by the Maternity Clinical Nurse Specialist, unit-based maternity committees reviewed  literature, assessed current practices, and implemented components of evidence-based practice. The Maternity Clinical Nurse Specialist collaborated with Labor and Delivery and NICU regarding practice changes.  Evidence-based practice guidelines for care of the late preterm on the postpartum/newborn unit included: Late-Preterm Infant Protocol/order sets; parent education materials; car seat challenge testing program; New Ballard Gestational Age Assessment tool; skin-to skin contact as standard of care; one-piece sleepers for thermoregulation; hyperbilirubinemia assessment and management;  and staff education. Outcomes included:  Improved nursing practice based on gestational age rather than routine care; improved parent education about health care issues of late preterm infants; early breastfeeding initiation and follow-up by lactation consultants; increased  staff awareness of the  vulnerability of late preterm infants; timely post-discharge pediatric follow-up; and  increased collaboration between nurses and physicians and among nursing units.   Gestational-age appropriate care has  reduced risk to the late preterm population. This presentation demonstrates that utilization of an evidence-based practice model can expedite the translation of research into practice to improve patient outcomes.