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Neonatal ICU/Newborn

Collaboration
JAMIE HAUSHALTER CPNP-PC, IBCLC
SHERRY LEBLANC NNP-BC
Setting

u 58 ICU bed spaces


u 16 L&D rooms
u 4 triage rooms
u 3 Operating Rooms
u 28 Mother-Baby rooms
u 13 Antepartum/High risk Post Partum
How it all started

u M&M 2014
u WHY
u Transfer rate
u Identifying the GAPS
u Task Force
u Algorithm Revision
u Gel
Identifying the GAPS

u Rapid transfer based solely on BG value – not ideal


u Wanted RN driven algorithm but provider eval/input prior to transfer
u Needed agreement between NBN & NCCC for what values required
transfer
u Understanding of process/workflow from L&D to NBN and NCCC
u Prioritizing BG within 1st hour over feeding
Hypoglycemia Task Force

u Neonatology Providers
u Newborn Nursery Providers
u Labor and Delivery
u Maternal Fetal Medicine
u Lactation
u Nursing Leadership
u Nursing Education
u Staff Nurses
Challenges

u Provider dependent decision making


u US versus THEM
u Days versus Nights
u Who to call
u Donor milk Location and access
u Best place for “transitional” baby
u Gel
u Orders
u Pyxis access
u Administration
u Symptomatic
Addressing Challenges

u Algorithm
u Utilizing same growth curves
u Best for BABY
u Pediatric Hospitalist Education/Division July 2019
u Donor milk share bottle
u Gel on L&D pyxis
u Orders: Nursing prompt
u BB Smith at risk *** weighing ***kg First BG is ***
Positives

u Improved working relationship between NBN & NCCC staff & providers
u Better understanding of each other’s workflows, limitations, etc.
u Standard algorithm / glucose goals: assists residents / learners
u Agreed upon criteria for transfer back to Mother-Baby / NBN
u United goal to keep mother/infant dyad together whenever possible
u Improved communication
On the Horizon

u Standing Orders
u Gel
u Formula
u Donor milk
u Symptomatic Algorithm
Questions??

u Jamie.Haushalter@unchealth.unc.edu
u Sherry.Leblanc@unchealth.unc.edu