Treating and managing asymptomatic at-risk newborns for hypoglycemia relies on sticking to the basics - reinforcing the clinical skills of obtaining a heel-stick blood sample is one intervention some teams have deemed a priority. Utilizing the PQCNC video titled, “Proper Heel-stick Demonstration” and the PQCNC illustration outlining proper puncture site, teams are requiring their staff to view these resources prior to performing return demonstrations of the skill. Some teams have even added these informative tools to their annual education blitzes and new hire orientations to ensure continued competency with the skill. Though obtaining a heel-stick blood sample is a high-frequency clinical task performed daily, teams have recognized incorrect habits have formed over time potentially leading to inaccurate results. Going back to the basics and reviewing this critical task is helping to ensure the most accurate blood glucose sample is obtained, resulting in optimal management of the newborn at-risk.
With much evidence pointing to the benefits of glucose gel as a viable, effective, and inexpensive treatment option, teams across the state are giving it a go. Utilizing the PQCNC webinar resources available to them is proving useful - teams are sharing the videos on proper glucose gel administration with all staff to educate them on proper technique to achieve optimal glucose absorption. With baseline data showing over 60% of teams not using gel as a treatment option, the potential to improve care provided to newborns, keep moms and babies together, and promote breastfeeding efforts by our highly engaged teams is tremendous. The video is available on the NHPC webinar page to view at any time to support implementation efforts.
After months of review and numerous discussions, considering all current North Carolina algorithms and evidenced-based recommendations, the Newborn Hypoglycemia Prevention and Care collaborative achieved one of the primary goals teams desired: a statewide protocol for Management of At-Risk Newborns for Hypoglycemia.
Over 250 attendees at the initiative kickoff last week solidified these efforts and approved the document after careful review and expert engagement. Mirrored after the 2011 American Academy of Pediatric (AAP) version, the North Carolina statewide algorithm takes it a step further and includes the use of glucose gel as an intervention.
Blessed by Dr. David Adamkin himself, the author on the statement on Neonatal Hypoglycemia for the AAP, the resource is meant to provide teams with a standardized protocol right out of the gates, as we begin our work to improve care for the hypoglycemic newborn and those as risk.
Find it in Initiative Charter/Work Plans/Action Plans here
Hypoglycemia is one of the most frequently encountered problems in the first 48 hours of life and low glucose concentrations are perhaps the most common biochemical abnormality seen by providers caring for newborns. Unfortunately, the optimal strategy for managing this problem remains elusive. Now is the time to join the state in standardizing care for hypoglycemia of the newborn.
To date, there are over 60 teams who are registered for the kickoff meeting on January 24, 2019 in Raleigh. Are you one of them? If not, now is the time to engage.
A day of collaboration with teams across North Carolina and a talk by a national expert in the field, is not something to miss. Dr. David Adamkin, author of the statement on Neonatal Hypoglycemia for the American Academy of Pediatrics, will discuss the brewing topic of “Neonatal Hypoglycemia, Making Sense of Different Opinions” to kickoff PQCNC’s Newborn Hypoglycemia Prevention and Care initiative.
The first step in getting to where you want to go is knowing where you are.
*Is there a nurse driven standardized algorithm to guide clinical management of asymptomatic newborns at-risk for hypoglycemia at your facility?
*Current approach to management of the asymptomatic at-risk hypoglycemic newborn aligns with:
Pediatric Endocrine Society guidelines
Locally derived management protocol
*Is there an IV weaning protocol in your unit for infants who receive continuous IV therapy solely for the treatment of hypoglycemia?
These questions and more are serving as the basis for an intensive review of the current 'state' of care for hypoglycemia. Comparing that state with identified best practices is part of the baseline work teams are undertaking to identify possible areas of improvement and prepare for the work ahead.
There are less than 100 days before the January 24, 2019 kickoff meeting where teams will develop their plan for success. If you are excited to collaborate, enthusiastic to share resources, and eager to engage in a project aimed at improving outcomes for newborns while keeping the mom and baby together then click here and register your team to begin preparations and commence PQCNC support!
The Newborn Hypoglycemia Prevention and Care expert team decided developing a statewide hypoglycemia protocol to manage the at-risk newborn should be a goal of this project. Utilizing evidenced-based practice and tapping into the expert knowledge of our providers across the state is how we plan to accomplish this.
If your unit currently has a hypoglycemia protocol or algorithm that guides clinical practice, please consider sharing it with PQCNC. Your unit practices will help develop a statewide clinical algorithm to help standardize care for newborns in North Carolina. Submit your algorithm here
If you are a hospital interested in improving your process of identifying and treating symptomatic and at-risk newborns for hypoglycemia within the first 48 hours of life, now is the time to join the effort. Go here, download the guide, and get started - once your team is registered, the PQCNC leadership team will support you over the next few months to ensure your team is prepared for success prior to kickoff.
The dedicated NHPC expert team has successfully completed the essential documents that will guide teams toward identifying and treating symptomatic newborns with signs and symptoms of hypoglycemia and asymptomatic newborns at-risk for hypoglycemia within the first 48 hours of life. The strength of this project lies in the primary goals all teams will aim to achieve: keeping the mother and infant dyad together, supporting breastfeeding and ensuring 100% of participating hospitals develop guiding protocols in their NICUs and newborn nurseries.
To join the efforts and improve the care of newborns in your facility click HERE
The NHPC expert team has made great progress in creating the goals and interventions that will drive the work teams do to consistently manage symptomatic and asymptomatic newborns at-risk for hypoglycemia. The team focused their efforts this month on how to successfully measure improvement for higher acuity units caring for the hypoglycemic infant. The creation of an IV dextrose weaning protocol that would guide clinical care and potentially decrease length of stay was one aspiration the team deems achievable. Building capacity between higher acuity units and normal newborn nurseries is the intention of the expert team as they define the work to drive a successful plan.