Neonatal glucose testing via prompted intervention during the pretransport phase of care.

Neonatal hypoglycemia is a common metabolic problem. Critically ill neonates require effective glucose metabolism to survive and thrive. Timely and urgent transport of these neonates from a level I/II nursery to a level III NICU is often needed related to complex medical and nursing care requirements. The stabilization phase prior to transport can be chaotic, resulting in a less than optimal frequency of glucose testing. Inadequate testing may result in undetected hypoglycemia that can lead to lifelong and serious neurodevelopmental sequela. The internationally utilized S.T.A.B.L.E. curriculum, which guides postresuscitation/pretransport stabilization, has an evaluative component known as the Pretransport Stabilization Self-Assessment Tool (PSSAT). This tool allows the referral hospital staff and transport team to track glucose levels during the pretransport phase of care at 3 distinct points in time. Utilization of the PSSAT has been shown to successfully prompt glucose testing that is reflective of the S.T.A.B.L.E. curriculum.

Infusion nursing: aspects of practice liability.

As the healthcare arena continues to evolve with the advent of novel clinical practices and technologies, the practice of infusion nursing is no exception to this phenomenon. Given this situation, it is imperative that nurses practicing infusion therapy be aware of the Infusion Nursing Standards of Practice to optimize patient care and safety and avoid potential litigious situations. Aspects of practice liability specific to the delivery of nursing care, product liability concepts, and a case study including the role of the nurse expert witness provide a basis for ascertaining the importance of adherence to these standards.

Decreasing NICU Costs in the managed care arena: the positive impact of collaborative high-risk OB and NICU disease management programs.

Costs for preterm and critically ill neonates in a neonatal intensive care unit (NICU) can be astronomical related to the number of inpatient day's accrued and professional ancillary fees. NICU births are often associated with maternal risk factors such as previous preterm or low birth weight delivery, maternal infections, chronic disease states, substance abuse and/or human immunodeficiency virus (HIV) infection. Accordingly, Johns Hopkins HealthCare provides a disease management approach for the prevention of NICU births through "Partners With Mom." This maternity disease management program identifies pregnant women that could potentially generate high-dollar claims. The mission of the program is to reduce hospital/NICU admissions related to pregnancy complications and improve maternal/neonatal outcomes. If an NICU birth does occur, multiple avenues are pursued to control costs. By working in concert with Partners With Mom, the NICU Disease Management Program utilizes a multifaceted approach by tracking maternal risk factors, optimizing levels of required inpatient neonatal care and pursuing other avenues of revenue enhancement.