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Sunday, June 24, 2012

Title: Neonatal Head Cooling: Implications for Community Hospital Nurses

Woodrow Wilson (Gaylord National Harbor)
Robin Lynn Underwood, MSN, RNC, CNS, APN , Women's and Children's Service Line, Bayhealth Medical Center, Dover, DE
Melody J. Wireman, MSN, RNC, CNS, APN , Women's and Children's Service Line, Bayhealth Medical Center, Dover, DE
Jennifer Ann Novack, MSN, RN., CNS, APN , Women's and Children's Service Line, Bayhealth Medical Center, Dover, DE

Discipline: Newborn Care (N)

Learning Objectives:
  1. Define neonatal head cooling eligibility criteria for hypoxic ischemic encephalopathy
  2. Identify nursing interventions that significantly reduce the risk of neonatal hypoxic ischemic encephalopathy
  3. Develop a "tool-kit" of potential strategies useful for community hospital nurses that will improve neonatal outcomes
Submission Description:
Objective:   Determine contributing factors to organization's high rate of neonates requiring head cooling treatment for hypoxic ischemic encephalopathy (HIE).  Design and implement strategies to reduce rate by 50%.

Background/Significance of Problem:  Although Bayhealth Medical Center delivered 18% of all live births for 2009 and 2010, 50% of all neonates requiring head cooling treatment for HIE were from this organization.

Design: Retrospective chart review and qualitative interviews with labor/delivery nurses assigned women whose neonates required head cooling for HIE.

Patients/Participants:  100% of maternal and neonates from May 2009 when head cooling at level III referral center began through January 2011.  Inclusion criteria:  neonate referred to Level III NICU for head cooling.  Exclusion criteria:  none

Methods:  PI audit tool developed with 250 different data elements.  Formal interview tool developed.  Clinical Nurse Specialists audited all charts that met inclusion criteria.  Charts that met specific red flag indicators were audited by independent ACOG physician consultants. 

Implementation Strategies:  Targeted hands-on nursing education for all Labor/Delivery nurses that included fetal strip interpretation, intrauterine resuscitation, oxytocin protocols, difficult conversation communication techniques, use of consistent NICHD language when interpreting fetal strips, prompt recognition of neonates that may meet head cooling criteria and policy review.  Additional electronic "nursing perinatal bundle" education included:  managing shoulder dystocia, operative vaginal delivery, advanced fetal assessment and monitoring, and SBAR-R.

Results:   During the past eight months there have been zero (0) neonates that have required head cooling treatment for HIE!

Conclusion/Implications for nursing practice: Nursing ownership and nurse-driven interventions dramatically improve patient outcomes.  Utilizing evidence-based practices and a systematic performance improvment process can facilitate achieving quality patient outcomes.  Nurses at community hospitals have tremendous impact on neonates that qualify for head cooling due to HIE.  Continuing auditing of charts when a neonate meets criteria for head cooling treatment of HIE.  Future plans include developing a multi-disciplinary perinatal safety team at the organization that includes medical staff, nursing staff and anxillary departments to improve both maternal and neonatal outcomes.

Keywords:  hypoxic ischemic encephalopathy, head cooling, neonatal outcomes

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