of Very Preterm Infants is Sustained in an Era of Increasing - - PowerPoint PPT Presentation

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of Very Preterm Infants is Sustained in an Era of Increasing - - PowerPoint PPT Presentation

Oct 23, 2022 374 likes •503 views

Optimal Thermal Management of Very Preterm Infants is Sustained in an Era of Increasing Duration of Cord Clamping Angela Huang, BSN, RNC-Nic angela.huang@hhs.sccgov.org Quality and Data Nurse Coordinator Santa Clara Valley Medical Center May

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SLIDE 1

Optimal Thermal Management

  • f Very Preterm Infants is

Sustained in an Era of Increasing Duration of Cord Clamping

Angela Huang, BSN, RNC-Nic angela.huang@hhs.sccgov.org Quality and Data Nurse Coordinator Santa Clara Valley Medical Center

May 26, 2017

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SLIDE 2

Background

  • Public safety net hospital with

a CCS regional level 3 NICU with approximately 400 admissions a year.

  • A standardized bundle

approach in the delivery room, elimination of hypothermia (<360C) (Manani et al 2013).

San Jose

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SLIDE 3

AIM

To sustain our established optimal temperature management while increasing duration of DCC in very preterm infants (<32 weeks GA or ≤1500 grams) born between 2008-2017

  • Hypothermia (<360C)
  • Suboptimal Thermal Management (<36.50C)
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SLIDE 4

Our standardized thermoregulation bundle has included DCC since July 2007.

Methods:

82% of VMC infants included in the CPQCC benchmark received DCC

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Outcome Measure 1

30s 60s 120s

Sustain 0% hypothermia rate (<36°C)

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SLIDE 6

Outcome Measure 2

30s 60s 120s

Decrease our suboptimal thermal management rate (<36.5°C) from 21% in 2011 to less than 10% (Inborn)

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SLIDE 7

Balancing Measure:

Hyperthermia rate (>37.5°C)

8% 2017 YTD: 0%

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SLIDE 8

Balancing Measure: Survival without major morbidities

(inborn)

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SLIDE 9

DCC and Multiples

DCC No DCC Total % DCC Di Di Twins 34 7 41 83% Mono-Di 47 8 55 85% Mono-Mono 3 1 4 75% Tri-Tri 12 12 100% Multiples 96 16 112 86%

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SLIDE 10

Data Collection

Customized in EMR OB Delivery Summary- evolved from static selection to continuous variable

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  • 1. Standardization of practice with OB residents:
  • Continuous education
  • OB Grand Rounds
  • 2. Communication with OB team
  • Review DCC goals before high-risk deliveries when

possible

  • Abruption, ELBW, general anesthesia, multiples,

anomalies

  • Reiteration and review outcomes with OB team
  • 3. Monitor and review our processes and outcomes
  • Debriefing

Challenges/Lessons:

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SLIDE 12

Conclusions

  • Increased DCC

duration from 30s to 2 minutes

  • No changes made to
  • ther

thermoregulation processes

  • Sustained optimal

admission temperature rate

  • Next step: focus on

reducing hyperthermia.