Purpose for the program: Strong evidence supports specialized care for vulnerable late preterm infants.  Care of these infants at four maternity facilities within a five hospital system was not protocol based and varied depending on physician preference and nursery level designation.  A multi-disciplinary team from the affected hospitals formed to develop a system-wide late preterm infant protocol with the goal of standardizing care.

Proposed change: Development and implementation of a late preterm infant protocol insures care is evidence-based and provides a framework for measuring patient outcomes.  The team agreed to develop a protocol for implementation within the current configuration of nursery designations and environments and with minimal effect on staffing and budgetary constraints.  The protocol required approval by the respective Departments of Pediatrics at each member hospital.  The team proposed a timeline of six to nine months for full implementation.

Implementation, outcomes and evaluation: Consisting of nurse managers, educators, neonatologists and staff nurses from the affected facilities, the team met monthly with work done individually between meetings. After a review of current practices and literature, areas of care were assigned to members for protocol development.  Drafts were reviewed electronically and revised, as indicated.  Administrative representatives from system and site finance and nursing pledged support for the practice change. The Director of Neonatology presented proposed protocol and documents supporting practice change to the Departments of Pediatrics and Obstetrics and Gynecology. Upon approval, nurse managers and educators developed individualized and site-specific education plans for team members, including evidence supporting the practice change.  Implementation occurred concurrently at all sites with posting of the new protocol on the system’s internal policy and procedure database.  Development and implementation of the protocol posed significant challenges.  The protocol required consideration of varying environmental and staffing configurations.  Providing the patient with the care in the protocol became paramount to how and where that care was provided.  Full implementation did not occur until one year after process initiation.  Chart reviews demonstrate consistent implementation of the protocol at all sites.

Implications for nursing practice: Nursing involvement in developing and implementing evidence based protocols validates practice decisions and affects patient outcomes.  The development of this particular protocol standardized care and created avenues for measuring outcomes for the late preterm infant.  Comparisons of readmission rates, weight loss during hospitalization and days to discharge pre and post protocol implementation are currently in progress.

Keywords: late preterm infant, protocol, nursery designation