Updates

Teams from across North Carolina convened in Raleigh on October 14th to hear presentations ranging from education plans for implementation of the PQCNC statewide hypoglycemia algorithm to various methods of EMR integration to achieve sustainability. Discussion topics included the use of donor breastmilk as supplementation in the at-risk for hypoglycemia term newborn, adopting glucose gel as a treatment, and the increase in the standardization and use of an IV weaning protocol for newborns who did require an escalation of care resulting in continuous IV infusion. 

See the days presentations

PQCNC created a state-wide algorithm to kickoff the Newborn Hypoglycemia Prevention and Care initiative to assist teams with a strong resource as they began standardizing the care and management of newborns at-risk for hypoglycemia.  However, one team took it a step further. Understanding there were many scenarios and steps their staff would have to interpret when they rolled out the PQCNC algorithm, Vidant Medical Center saw an opportunity to ease implementation for their staff.  They added line items on the algorithm for staff to document blood glucose results, as well as time of testing and treatment if carried out. The document is not only a guide for standardization it is now a working algorithm to ensure the protocol produces an accurate clinical pathway every time.  The team also plans to collect these tools to track compliance and identify opportunities for further implementation support if necessary.

Diagnosis of gestational diabetes (GDM), large for gestational age, small for gestational age and maternal use of beta-blockers, represent the most common risk factors threatening a newborn with hypoglycemia at birth.  These maternal indications can largely be determined prior to delivery and therefore, beginning to partner with parents before birth is an optimal time to educate.

WakeMed Health and Hospitals, in Raleigh, decided to do just that.   Working closely with their public relations department to convert the PQCNC parent education form to include their hospital logo, the team successfully produced two documents, one in English and one in Spanish.  The nurse leaders on the postpartum floor then reached out to the leaders of the high-risk obstetric clinic and health department to educate them on the PQCNC project and goal they were trying to achieve.  Aiming the education at mothers 26 weeks and greater, the clinic and health department have added the hypoglycemia documents to their current information packet.  Once they deliver, the same education is presented again in the inpatient setting as well.  Mothers with the above risk factors can now be aware of what to expect both before delivery and after. 

We commend the WakeMed team for thinking outside the inpatient setting and beginning to partner with patients before birth to optimize the care provided to their newborns!

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.