Dr. Hajj was on call one evening for an extremely low birth weight infant. She felt that it took a long time to get Early TPN initiated. She completed a chart review for all infants born < 30 weeks and/or< 1500 grams and brought the results to the monthly Neo Committee/QAPI Meeting. She proposed that a QI project should be initiated based on the data. This project meets the MHHS vision of creating healthier communities for generations to come because the infants in the NICU are the next generation. The Golden Hour QI project is values-driven and based on current best practice evidence. NICU standard of care is glucose check and glucose-containing fluids to start within 60 minutes of birth for the target population to prevent harmful neurologic effects from hypoglycemia. Armed with the knowledge that we were not meeting industry benchmark, we took on the task of developing a team-based process with specified roles to tackle the problem and strive to meet benchmarks. Analysis of current practice and barriers as well as projected future process was completed. The planning had a multidisciplinary approach with multiple interventions and a sequenced education plan for all stakeholders.
It takes a village to get a tiny baby admitted and settled after birth and the Golden Hour QI project has increased the teamwork in the unit. Birth is a highly stressful event for a preterm infant. The institution of the Golden Hour Process has reduced the length of touch time and exposure to a loud environment outside of the isolette to less than 60 minutes. With the team focus and collaboration, there has been more staff at the bedside to settle the infant which has also enabled there to be a support person for the parent at the bedside and has allowed for early teaching. High-quality safe care is our priority as evidenced by our results. We tackled a challenging change to the NICU culture during construction in our unit. Our solutions were innovative and will have a long-term impact on the achievement of developmental milestones for our tiniest infants. Dr. Hajj identified the problem and was the medical team contact for the project.
The time to start early TPN in the identified population was reduced from an average of 2 hours 21 minutes to 48 minutes post education and initiation of the Golden Hour process. The initial glucose within the normal range was improved from 31.8% pre to 71% post.