376 - Implementation of a Small Baby Bundle in a Level IV NICU

Poster Number: 376
Publication Number: 376.434

Hannah Jolley, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Gabrielle DeAbreu, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Queens, NY, United States; Emma E. Konieczny, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Queens, NY, United States; Cynthia Rasmussen, Division of Neonatal-Perinatal Medicine,Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Garden City South, NY, United States; Kamesha K. Bailey, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Floral Park, NY, United States; Denise Pena, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Garden City, NY, United States; Zachary H. Ibrahim, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Merrick, NY, United States; Barry Weinberger, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Vita Boyar, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States

Background: Preterm infants are exposed to iatrogenic stressors that may contribute to adverse outcomes. For example, weighing infants, performing cuff blood pressures, and prolonged line placement can cause hypothermia and blood pressure fluctuations. Intraventricular hemorrhage can be reduced by small baby care bundles that decrease stimulation in the first week.

Objective: To facilitate care and minimize nonessential interventions for preterm infants ( < 30 wks and/or < 1500 g) during the first week. The SMART aims were to: 1) decrease weight measurements to only days 1, 4, and 7 for > 80% of infants, 2) decrease performance of cuff blood pressure (BP) measurements to < 10% of infants with arterial lines, and 3) decrease times to start and completion of umbilical line placement by 20%, by December 1, 2021.

Design/Methods: A multidisciplinary team implemented an evidence-based practice bundle for minimal stimulation. Several PDSA cycles were performed to accomplish targeted bundle elements, including: 1) conferences and nurse educator sessions, with laminated bedside cards, 2) just-in-time coaching for bedside nurses, 3) interval reminders to on-service teams, and 4) departmental presentations and posters. Balancing measures were changes in total fluid intake and frequency of treatment for hypotension.

Results: Weight measurements decreased quickly after nursing education to a median of 80% bundle compliance (Fig. 1). Similarly, the number of cuff BP measurements decreased by 84%, from a mean of 17.1 to 2.7 per infant with umbilical line during the first week (Fig. 1). Mean time to start umbilical line placement decreased by 11% after bundle roll-out and decreased further after specific interventions targeting the medical team (Fig. 2). Times to complete umbilical line placement remained unchanged at 111 minutes (Fig. 2). Total fluid intakes and the incidence of hypotension were not affected.Conclusion(s): Alterations in nursing practices to decrease agitation of preterm infants (fewer weights and cuff BPs) are readily acceptable and easily adopted. Our experience suggests that minimal intervention has intuitive appeal and that decreasing tasks is easier than increasing them. In contrast, time to starting umbilical lines improved only after programs targeting both nurses and medical providers, which underscores the requirement for interdisciplinary coordination. To improve time to line completion, training for medical providers will be modified to emphasize efficiency and better utilization of team resources.
Figure 1: Blood Pressure Measurements and Weights
Figure 2: Timing of Umbilical Line Placement