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Transforming Care At The Bedside (TCAB)
NICU: Improving Patient Outcomes
Improving Patient Outcomes
Design Target• Patient Centeredness• Safety and Reliability• Lean
Problem Identification• Feedback from physician regarding
delay in obtaining admission blood gas sample
Goals• To provide a timely assessment and treatment of
neonates admitted to the NICU for respiratory distress
• Streamline NICU admission process
Population
Criteria • Neonates admitted from Labor & Delivery to the NICU with respiratory distress
Subjects• Pre-Data n=31• Post-Data n=30
Time frame • Pre-Data May 1- June 29, 2015• Post-Data July 15 – August 19, 2015
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Pre-Data
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Time from NICU Admission to Initial Blood GasMay 1 - June 29, 2015
MINUTES
Average time 57.5 minutesRange of time 15 -142 minutes
Pre-Data
May 1-7 (6 Patients)
May 8-14 (2 Patients)
May 15-21 (4 Patients)
May 22-28 (1 Patient)
May 29-June 4 (0 Patients)
June 5-11 (9 Patients)
June 12-18 (4 Patients)
June 19-25 (2 Patients)
June 26-July 23 (3 Patients)
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Average Minutes from Time of NICU Admission to Initial Blood Gas
Average Minutes per Week
Week Average Minutes
1 62.22 42.53 794 335 n=06 51.37 54.88 879 40
Pre-Data
•15 out of 31 blood gas results were not within defined limits
•6 out of the 15 blood gas results were critical and required further interventions
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Intervention
• Notified NICU Admit Team Members of identified problem, pre-data, and planned change
• Discussed planned change with Medical Team at MD/RN Collaborative Practice
• Established Admission Priority List
• Modifications made to NICU Labor & Delivery Cart
• Start of shift handoff huddles with Admit Team
Admission Priority List
Place the Heel Warmer on the infant in the OR/LDR prior to transporting the infant to the NICU
Obtain a baseline temperature @ 5mins of life in the delivery room Increase bed temperature to 37c or double wrap the infant in a baby blanket Use a Chemical Mattress unless contraindicated
Notify the NICU Charge Nurse of the admission Charge Nurse will designate the Bay and Bed placement for the infant. Charge Nurse will notify the NCT to transfer the infant into the NICU census
Remove the Heel Warmer and Weigh Infant Place the leads to obtain vitals Admit RN1 will perform the heel stick and obtain GLUCOSE, HCT and Blood Gas if
the infant is in respiratory distress RT will run the Blood Gas and Admit RN2 will run the Glucose and HCT
Obtain Temperature Start IV (left hand) Obtain labs: CBC, Blood Culture etc. Administer ordered ABX after the IV start and lab draw Administer critical meds immediately Perform Blood Pressure (4 extremities) and Pre/Post SPO2 readings Measurements
* Depending on the type of admission; follow the priority list with the exception of hypothermia protocol infant. Hypothermia priority is to set up the cooling blanket and obtain IV access immediately upon admission. * For planned deliveries- admission set up should be prepared to avoid delay in care. Have iStat, cartridges, IVFs, blood culture bottle and suction set up on the cart.
Post-Data
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Time from NICU Admission to Initial Blood GasJuly 15 - August 19, 2015
MINUTES
Average time 19.5 minutesRange of time 7 – 33 minutes
Post-Data
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July 15 - 18 (1 Patient)
July 19 - 25 (10 Patients)
July 26 - August 1 (4 Patients)
August 2 - 8 (4 Patient)
August 9 -15 (5 Patients)
August 16 - 22 (6 Patients)
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Average Minutes from Time of NICU Ad-mission to Initial Blood Gas
Average Minutes per Week
Week Average Minutes
1 332 17.73 20.74 13.255 17.66 14.8
Results
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• Decreased average time from NICU Admission to Initial Blood Gas by 38 minutes
• Interventions are performed for abnormal blood gas results in a timely manner
• Streamlined NICU admission process using Admission Priority Checklist
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Pre-Data
Post-Data
MINUTES
Lessons Learned
• Education of NICU Admit Team regarding importance of timely blood gas results
• Discovered how frequently delayed interventions occurred for critical blood gas results
• Checklist assisted with prioritizing admission workflow
• Established goal of 30 minutes for obtaining blood gas results
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