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PQCNC NHPC Learning

Session 3
March 10, 2020
Keep Moms and Newborns Together

Non-breastmilk Sustainability IV Infusions


Supplementation

20% 25% 25%

Standardized Transfers to
Protocol SCN/NICU
Post
Pre
Snapshot
80%

Standardized
Hypoglycemia Nurseries who had a standardized protocol before
February 2019
Protocol
Post
Pre
Snapshot
10%

Standardized IV
Weaning Protocol Nurseries who had a standardized IV weaning protocol before
(Nurseries/NICUs) February 2019
Post
Pre
Snapshot
Snapshot 34%

Glucose Gel Nurseries who used Gel as an


intervention before February 2019
Post
Pre
Snapshot
Snapshot
Hypoglycemia Nurseries who had a hypoglycemia order

Order set in set integrated in EMR before February


2019
EMR
Post
Pre
Snapshot
Snapshot 45%

Hypoglycemia Nurseries
Nurseries who
with have
documentation
hypoglycemia
hypoglycemia
integrated
documentation
education
education
in before
in EMR EMR by February
Education February2020
2019

documentation
in EMR
Post
Snapshot
PQCNC
Hypoglycemia
Education

57%

Nurseries who have utilized the PQCNC


hypoglycemia education resource
by February 2020
GEL Update- As of 3/2/2020…
“Next Few Weeks”(they are building inventory before go-live)
NBN Data and Engagement

41 teams entered data from


facilities delivering 53,000
babies or

of newborns in NC
Percentage of Newborns Identified as Hypoglycemic

12 12 12 12

11 11 11 11 11
38%
9
Increase in
8 Reporting

FEB-19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19
Gel Implementation Timeline

19 teams 21 teams 28 teams 38 teams


giving gel giving gel giving gel giving gel

Prior to By By
By June
February August December
2019
2019 2019 2019
Percentage of All Hypoglycemic Newborns Transferred

28 teams 38 teams
giving gel giving gel
21 teams
giving gel

19 teams
giving gel

14 14 14 14 13 13 14
12 12
10 10

FEB-19 MAR-19 APR-19 MAY-19 JUN-19 JUL-19 AUG-19 SEP-19 OCT-19 NOV-19 DEC-19
Percentage of Hypoglycemic Newborns treated with Gel that
were Transferred
(for those 19 teams using gel prior to project)

26
24
23
22%
20
18 18 18 18 18
17
15

FEB-19 MAR-19 APR-19 MAY-19 JUN-19 JUL-19 AUG-19 SEP-19 OCT-19 NOV-19 DEC-19
Percentage of Hypoglycemic Newborns treated with Gel that were
Transferred
(includes all teams using gel Feb to Dec 2019)

31
30

24
23 23
22 17%
21
20
19
18

15

FEB-19 MAR-19 APR-19 MAY-19 JUN-19 JUL-19 AUG-19 SEP-19 OCT-19 NOV-19 DEC-19
Tale of Two Gel Experiences
Percentage of Hypoglycemic Newborns BF in the first 60 Min of
Life
57
56
54
53
52 52 52
50 50
49
33%
42

FEB-19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19
Percentage of Hypoglycemic Newborns BF at Discharge

43

42

41 41 41

40

38 38

37

36 36

12%

FEB-19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19
Percentage of Hypoglycemic Newborns STS within the first 4
hours

81 81 80 80 80
78
76 76
73

64
62

FEB-19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19
Percentage of IV's Weaned by a Protocol

94

81 81

70
65 65 65 200%
59
54

38

27

FEB '19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19
Percentage of Hypoglycemic Newborns Transferred to NICU who did
NOT get an IV

25 25

19
18 18
17

15
14
13
28%
11 11

FEB '19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19
Average duration of IV Fluids for Hypoglycemic Newborns

40 Hours
47%
5%/8% of teams had
a Weaning Protocol
21 Hours

77% of teams had


a Weaning
Protocol

FEB '19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19 JAN '20
NICU Length of Stay (hours)
160

140

120

100
HOURS

80

60
38%
• Average NICU LOS Reduced by 48 Hours
• Average 85 infants per month
40 • Annually eliminate 2040 NICU days
• Estimate $4,080,000 savings
20

0
FEB '19 MAR '19 APR '19 MAY '19 JUN '19 JUL '19 AUG '19 SEP '19 OCT '19 NOV '19 DEC '19
Did we make it to the top? Are we done?
Lessons Learned
• Gel must be accompanied by all hypoglycemia bundle elements
• Skin to Skin
• Early feeding
• Gel alone is the equivalent of giving a 2 cc/kg bolus of D10W with no maintenance fluids
• Potentially a glucose surge followed by insulin surge
• Feeding discipline and attention must be maintained
• Early feeding
• Lactation support
• Waiting until after 1st feed to check sugar (90-120 minutes of life)
• Several centers identified lapses in attention to feeding after initial resolution of
hypoglycemia (24-48 hours)
• Some report ordering of gel but challenges with its timely arrival
• Gel can decrease transfers and need for IV fluids but requires a coordinated team
approach
Lessons Learned
• Infants admitted for hypoglycemia more often receiving IVF
• Even so…NICUs were able to dramatically reduce NICU days for
hypoglycemia using a standardized weaning protocol
• We have opportunities to improve skin to skin and breastfeeding
rates for infants at risk for hypoglycemia
The NHPC Guideline
Going Forward for NHPC
• Review your data and processes and determine areas for PDSA work
• Early feeding, timing of glucose checks, skin to skin, attention to
continued feeding
• Review gel availability
• Review and audit gel administration
• In NICUs review numbers of infants receiving IV fluids and adherence
to weaning protocol
NHPC Sustainment
• We will miss you!
• Let’s stay in touch
• DELPHI will remain open
• What about a spot check for NHPC data in September?