Documents

For those of you requiring IRB approval click here

 

Pre-work/Work Action Plan 

Required pre-work/work for participation in NHPC - download the guide here

 

Joining the Initiative

Please submit a PQIT Roster for your team

Roster Changes: Please make sure to submit any changes in your team roster.  We would like to be able to provide all team members with the latest information about the initiative and we can only do that with your help.

 

Snapshot

Download the NICU Snapshot here - When you have completed the questions click here to enter your data

Download the NBN Snapshot here - When you have completed the questions click here to enter your data

Download the NBN PC05 Snapshot here - When you have completed the questions click here to enter your data

 

 

Initiative Charter/Action Plans/Work Plans 

PQCNC NHPC Charter

PQCNC NHPC Action Plan

Management of At-Risk Newborns for Hypoglycemia

IV Weaning protocol for Newborns with Hypoglycemia - Whether you're a hospital that has a Level 1 nursery or a Level 4 NICU, if you administer IV therapy, this weaning protocol can optimize treatment in newborns less than 48 hours old.  Written as a provider driven protocol, this resource aims to standardize and guide clinical decisions for both asymptomatic and symptomatic hypoglycemic newborns who require IV glucose treatment. 

Tracking Tool to support Hypoglycemia Protocol Implementation

Tracking Tool to Support Hypoglycemia Protocol Implementation 2.0 - updated by the folks at Caromont to include two additional criteria, has an apgar score at 1 minute of less than 6 and has signs or symptoms of low sugars

 

Initiative Data: The official start date for Initiative Data Collection is February 01 2019.    

PQCNC NHPC Newborn Monthly Data Collection

PQCNC NHPC Newborn Data Collection

PQCNC NHPC Newborn Data Dictionary

PQCNC NHPC NICU Monthly Data Collection

PQCNC NHPC NICU Data Collection

PQCNC NHPC NICU Data Dictionary

 

Accessing Reports

Attention Data Collectors:  

Instructions on how to obtain access to Delphi to submit data.

 

Webinars: 

A multitude of webinars will be available on-demand to assist you in your work

 

Team Meetings: 

Your team will need to schedule at least monthly meetings to review data, make plans for PDSA cycles, and plan for next steps. 

 

Executive Champion:

Please set up times to meet with your Executive Champions to update them on your progress and to ask for their help to meet your goals. PQCNC would suggest you meet with them every other month but no less than every quarter.

Tracking tool to support Hypoglycemia protocol implementation - PQCNC was proud to partner with Catherine Bennett CNS, from Advocate Lutheran General Hospital in Illinois, to bring North Carolina teams this supportive tool to measure compliance of how well your unit hypoglycemia at-risk algorithm is being followed. Simple instructions to optimize use of the tool are as follows:

Simple instructions to optimize use of the tool are as follows:

  • Ensure nurses caring for at-risk hypoglycemic newborns are educated on the tool (they will own the success of this process)
  • Instruct them to introduce the tool to parents of the at-risk newborn, taking the time to outline why the tool is important, why they are monitoring their newborn and the importance of them calling the nurse prior to feeding so a pre-prandial glucose level can be obtained. (excellent opportunity to educate family)
  • Each time a feeding and/or intervention occurs, it should be documented on the tool
  • Once newborn is discharged, no longer being monitored or transferred for higher acuity care, the form should be collected and reviewed 

 

Useful Resources

Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial - This seminal article has shaped the management of neonatal hypoglycemia. This study out of New Zealand recommends treatment with dextrose gel be considered the first-line treatment to manage hypoglycemia in late preterm and term babies in the first 48 hours after birth.  The authors concluded dextrose gel is inexpensive, simple to administer and can successfully reverse newborn hypoglycemia. 

Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter, is the most common metabolic problem in newborns. Major long-term sequelae include neurologic damage resulting in mental retardation, recurrent seizure activity, developmental delay, and personality disorders. Some evidence suggests that severe hypoglycemia may impair cardiovascular function.

Outcome at two years after dextrose gel treatment for neonatal hypoglycemia; Follow up of a randomized trial -  This follow up study to the Sugar Babies paper confirms that treatment with dextrose gel is not associated with additional risks or benefits at two years of age.  The authors claim that clinicians and families can be reassured that the advantages of treatment with dextrose gel soon after birth are not counterbalanced by increased risk of poor neurodevelopmental outcomes at two years’ corrected age. 

Clinical Report—Postnatal Glucose Homeostasis in Late-Preterm and Term Infants - Published in Pediatrics, this report provides a practical guide and algorithm for the screening and subsequent management of neonatal hypoglycemia. Highlighting the fact that no rigorous scientific definition has been reached, this influential article from 2011, continues to be endorsed today as the guidelines to manage neonatal hypoglycemia by the American Academy of Pediatrics.

Early skin-to-skin contact for mothers and their healthy newborn infants. - This extensive Cochrane review discusses the general consensus that “minimally, skin to skin contact should continue until the end of the first successful breastfeeding in order to show an effect and to enhance early infant self-regulation.”  Cited in this article as one of the common reasons for separation is hypoglycemia.  The review highlights evidence for a clinically meaningful increase in blood glucose in infants who received skin to skin contact and goes on to say that even if practiced for a “short time at birth [skin to skin contact] should have measurable breastfeeding effects one to four months’ post birth.”

New approaches to management of neonatal hypoglycemia. - This very informative article focuses on the role of buccal dextrose gel in the management of asymptomatic neonatal hypoglycemia and encourages the use of dextrose gel as part of a treatment protocol.  Additionally, the authors support the abandonment of the intravenous dextrose bolus for the treatment of asymptomatic, hypoglycemic late preterm, LGA, SGA/IUGR, and IDM newborns.

 

 

Pre-work/Work Action Plan 

Required pre-work/work for participation in RPC - download the guide here

 

Joining the Initiative

Please submit a PQIT Roster for your team

Roster Changes: Please make sure to submit any changes in your team roster.  We would like to be able to provide all team members with the latest information about the initiative and we can only do that with your help.

 

Snapshot

Download the Snapshot here - when you have completed the questions click here to enter your data

 

Initiative Charter/Action Plans/Work Plans 

PQCNC RPC Charter

PQCNC RPC Action Plan

PQCNC RPC Facility Intervention Tracker

PQCNC RPC Project Planning Form

 

Initiative Data: The official start date for Initiative Data Collection is January 01 2019.

 

PQCNC RPC Data Collection Plan

PQCNC RPC Patient Data Collection

PQCNC RPC Patient Data Collection Dictionary

PQCNC RPC Monthly Data Collection

PQCNC RPC Education Process Measures

PQCNC RPC Bundle Compliance Process Measures Data Collection

PQCNC Bundle Compliance Audit Sheet

PQCNC RPC Process Measures Data Dictionary

 

Delphi Bulk Data Submission

PQCNC RPC BUlk Data Submission - instructions for preparing and submitting your data

PQCNC RPC Bulk Data Submission Sample Spreadhseet - sample spreadsheet containing an example of each type of CSV for submission

 

Accessing Reports

 

Attention Data Collectors:  

Instructions on how to obtain access to Delphi to submit data.

 

Webinars: 

A multitude of webinars will be available on-demand to assist you in your work

 

Team Meetings: 

Your team will need to schedule at least monthly meetings to review data, make plans for PDSA cycles, and plan for next steps. 

 

Executive Champion:

Please set up times to meet with your Executive Champions to update them on your progress and to ask for their help to meet your goals. PQCNC would suggest you meet with them every other month but no less than every quarter.

READINESS

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

Childbirth Connection, Hormonal Physiology of Childbearing:  Fact Sheets on Core Topics  - this set of fact sheets from Childbirth Connection outlines hormonal changes through the process of labor and delivery, highlighting how to support hormonal changes during non-physiologic birth.

Maternal preference for cesarean delivery - do women get what they want?  - this article discusses the association between maternal preference for cesarean delivery and the actual mode of delivery experienced.  Women who preferred a cesarean delivery were more likely to ultimately deliver via cesarean section.  Education to address concerns regarding vaginal delivery are important in reducing primary and overall rates of cesarean section.

Low-risk, primary cesarean births in Medicaid:  National Association of Medicaid Directors/Association of Maternal and Child Health Programs Issue Brief 2015  - this brief outlines several strategies for Medicaid payment approaches with providers to decrease the primary and overall cesarean delivery rate.  Realizing that multiple approaches will be required to successfully decrease cesarean deliveries, partnerships between state agencies are also explored.

Consequences of a primary elective cesarean delivery across the reproductive life  - this article measured maternal morbidity associated with elective primary cesarean delivery versus a trial of labor.  Measured complications of delivery included transfusion, operative injury, deep venous thrombosis, hysterectomy and death. 

Safe reduction of the primary cesarean delivery  - this consensus statement by the American College of Obstetricians and Gynecologists discusses the indications for cesarean delivery, the risks of adverse maternal and neonatal outcomes by mode of delivery, the cesarean delivery rates across the United States, and offers guidance on clinical management in each stage of labor to reduce cesarean deliveries.  The initial statement was published in 2014 and reaffirmed in 2016. 

 

RECOGNITION

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

AWHONN Women’s Health and Perinatal Nursing Care Quality Refined Draft Measures Specifications  - the draft, released in 2014, defines nursing care quality measures defined by AWHONN to improve care provided to women and children.

Primary Cesarean Delivery in the United States  - this article describes a large retrospective cohort study examining indications for primary cesarean section and highlights opportunities to lower the primary cesarean rate and thus the total cesarean rate.

CRICO Clinical Guidelines for Obstetrical Services - Guideline 15:  Assessment and Monitoring in Labor and Delivery  - this document provides guidelines for the clinical provider to include admission to labor and delivery, initial evaluation of the patient and continues through first and second stages of labor and delivery of the infant.  Also included are guidelines for patient education during and after labor and delivery.

Cesarean deliveries, outcomes and opportunities for change in California:  Toward a public agenda for maternity care safety and quality  - this white paper provides an in-depth summary of the practices behind the rising cesarean delivery rates in California.  The summary provides recommendations for decreasing cesarean delivery rates to include quality improvement, payment reform and education that can be implemented effectively in any state.

Preventing the First Cesarean Delivery:  Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal- Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop - this article summarizes the content and discussion provided at a workshop supported by the National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists on preventing primary cesarean delivery.  The discussion includes indications for delivery, labor management practices, diagnosis of arrest disorders, operative vaginal delivery, evaluation of fetal status before and during labor, and non-medical factors contributing to primary cesarean delivery.  Algorithms for the management of induction of labor, assessment of intrapartum fetal heart rate monitoring and spontaneous labor are included. 

 

RESPONSE

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

AWHONN Women’s Health and Perinatal Nursing Care Quality Refined Draft Measures Specifications  - the draft, released in 2014, defines nursing care quality measures defined by AWHONN to improve care provided to women and children.

Primary Cesarean Delivery in the United States  - this article describes a large retrospective cohort study examining indications for primary cesarean section and highlights opportunities to lower the primary cesarean rate and thus the total cesarean rate.

CRICO Clinical Guidelines for Obstetrical Services - Guideline 15:  Assessment and Monitoring in Labor and Delivery - this document provides guidelines for the clinical provider to include admission to labor and delivery, initial evaluation of the patient and continues through first and second stages of labor and delivery of the infant.  Also included are guidelines for patient education during and after labor and delivery.

Labor and delivery teamwork leads to fewer cesareans  - this article describes the collaborative practice experience between midwifery, laborists and obstetricians at a hospital in California at the Society for Maternal-Fetal Medicine 2015 Annual Pregnancy Meeting.  This model was able to demonstrate a decline in the rate of cesarean delivery for nulliparous women and an increase in the rate of vaginal birth after cesarean delivery.

Cesarean deliveries, outcomes and opportunities for change in California:  Toward a public agenda for maternity care safety and quality  - this white paper provides an in-depth summary of the practices behind the rising cesarean delivery rates in California.  The summary provides recommendations for decreasing cesarean delivery rates to include quality improvement, payment reform and education that can be implemented effectively in any state.

Safe reduction of the primary cesarean delivery  - this consensus statement by the American College of Obstetricians and Gynecologists discusses the indications for cesarean delivery, the risks of adverse maternal and neonatal outcomes by mode of delivery, the cesarean delivery rates across the United States, and offers guidance on clinical management in each stage of labor to reduce cesarean deliveries.  The initial statement was published in 2014 and reaffirmed in 2016. 

Preventing the First Cesarean Delivery:  Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal- Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop - this article summarizes the content and discussion provided at a workshop supported by the National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists on preventing primary cesarean delivery.  The discussion includes indications for delivery, labor management practices, diagnosis of arrest disorders, operative vaginal delivery, evaluation of fetal status before and during labor, and non-medical factors contributing to primary cesarean delivery.  Algorithms for the management of induction of labor, assessment of intrapartum fetal heart rate monitoring and spontaneous labor are included.

 

REPORTING

Labor and delivery teamwork leads to fewer cesareans  - this article describes the collaborative practice experience between midwifery, laborists and obstetricians at a hospital in California at the Society for Maternal-Fetal Medicine 2015 Annual Pregnancy Meeting.  This model was able to demonstrate a decline in the rate of cesarean delivery for nulliparous women and an increase in the rate of vaginal birth after cesarean delivery.

Consequences of a primary elective cesarean delivery across the reproductive life  - this article measured maternal morbidity associated with elective primary cesarean delivery versus a trial of labor.  Measured complications of delivery included transfusion, operative injury, deep venous thrombosis, hysterectomy and death. 

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