Purpose for the program:  A trend of term newborns requiring transfer from the Newborn Nursery to the NICU was identified in a Level III NICU at a Magnet hospital.  This offering will detail the pragmatic strategies utilized to decrease NICU admissions of high risk transition newborns and present specific obstetric related diagnoses.

Proposed change:  To develop standards in clinical practice to promote newborn stabilization specific to newborns delivered at 35 – 36 weeks, born to mothers with a diagnosis of chorioamnionitis or diabetes receiving IV insulin during labor.  Nurses are critical to assess, plan, act, and evaluate care for high risk transition newborns to improve clinical outcomes and increase efficiency.  

Implementation, outcomes and evaluation:  A collaborative team approach was taken to establish clinical criteria to identify infants at risk of transfer to NICU.  Standards were developed for newborns at 35-36 weeks gestation, born to mothers with a diagnosis of chorioamnionitis or diabetic receiving IV insulin during labor. These infants, high risk transition newborns, are admitted to NICU for up to 6 hours of observation. Glucose management, breastfeeding, and newborn admission policies were revised to reflect new processes. The criteria and interventions were standardized and embedded into practice. A multidisciplinary approach was utilized to assure all care providers involved with maternal-newborn care received education, including process flow charts, algorithms, and reference cards. The criteria were communicated to the family prior to delivery to assure inclusion with all aspects of care. Families are aware of where their newborn will be admitted, fostering family centered care.  Since July 2008, term hypoglycemia transfers from the mother-baby unit (MBU) to NICU decreased 15%, admission of high risk transition newborns to NICU increased 27% and transfer of all newborns back to MBU is about 80%.

Implications for nursing practice:  Clinical criteria to identify newborns at risk for instability during extrauterine transition of life were standardized and embedded into practice.  This criteria provided necessary collaborative nursing and medical management of the newborn patient care for the Newborn Nursery RN and the Primary Care Pediatrician.  Clinical autonomy was maintained for the NICU nurse providing care to the newborn during the transitional time frame.  Standard processes and care requirements enabled nurses in a NICU to make prudent and timely decisions to improve neonatal outcomes. Improved quality outcomes for the newborn and improved patient satisfaction are a direct result of a standardized plan of care for high risk transition newborns. 

Keywords: Transitional NICU; Transitional Newborn Nursery; Observational Nursery