Purpose for the program: The late preterm infant (LPI) faces many challenges associated with prematurity. In 2010, 99 LPIs were born at Peninsula Regional Medical Center (PRMC), approximately 5% of the total birth volume. Nearly 29% of these infants were admitted to the NICU and 12.8% were readmitted to Pediatrics for complications associated with prematurity. The purpose of this program is to determine if adopting an evidence-based model of care, utilizing AWHONN's Assessment and care of the late preterm infant: Evidence-based clinical guideline (2010), will improve clinical outcomes and reduce NICU admissions and Pediatric readmissions for the LPI.

Proposed change: To adopt, institute, and practice AWHONN's clinical guidelines for every infant born between 34.0 and 36.6 weeks gestation at PRMC.

Implementation, outcomes and evaluation: Data collection took place over a six month period to determine baseline rates of hypothermia, hypoglycemia, respiratory distress, feeding difficulties, phototherapy, excessive weight loss, NICU admissions and pediatric readmissions.   A multi-disciplinary team developed the late preterm infant initiative utilizing AWHONN's clinical guidelines.  Components of the initiative include policy and order set development, pre-delivery and pre-discharge education, and individualized feeding plans.  Beginning March 22, 2011, all LPIs are admitted to the Intermediate Care Nursery and cared for with a nurse to patient ratio of 1:3-4.  All aspects of the clinical guidelines are utilized based on the individual needs of the infant. Data collection on these infants began May 1, 2011.  To date, 31 LPIs have been cared for under the new initiative. Eight of these infants were subsequently admitted to the NICU (25.8%) and zero have been readmitted to pediatrics.  The overall goal is to improve clinical outcomes while reducing admissions to NICU by 10% and readmissions to Pediatrics by 5% as compared with 2010 rates.

Implications for nursing practice: As the primary bedside caregiver, nurses are extremely vested in their patient's outcomes.  This initiative has led to an increased staff awareness of this population, their unique needs, and the challenges they face.  This knowledge, coupled with the utilization of evidence-based care, translates into improved clinical outcomes for the LPI.  This initiative has also improved teamwork and communication and has fostered relationships between nursing and other health professionals. Family-centered care is at the core of obstetric nursing, as well as this initiative.  Providing care that enhances family bonding, empowers parents, and improves clinical outcomes increases both patient and nurse satisfaction.  In this era of rising healthcare costs and non-reimbursement for preventable readmissions, it behooves nurses to adopt practices that anticipate and prevent possible sequelae related to late prematurity.

Keywords: late preterm infant, evidence-based practice