ABSTRACT
BACKGROUND: The birth of a very low birth-weight (VLBW) infant occurs infrequently, especially in the community hospital setting. It is critical that the team managing care of the infant in its first minutes of life follow evidence-based resuscitation guidelines and practices to optimize outcomes for this population. PURPOSE: To implement a simulation program in a community hospital setting that supports standardized evidence-based delivery room practices of the premature infant born less than 30 weeks' gestation. METHODS: Two VLBW emergent delivery scenarios were developed utilizing the neonatal resuscitation program scenario template. Special care nursery interprofessional team members from a community hospital were invited to participate in the simulation program (n = 28). Participants were asked to complete a neonatal version of the Emergency Response Confidence Tool, then view a short presentation related to delivery room management of VLBW infants. Participants attended a simulation program and completed the confidence tool after simulation. The simulation facilitator and unit educator documented team actions during each simulation session. FINDINGS/RESULTS: Fifteen opportunities for improvement within 4 simulation sessions were identified and categorized. Fourteen paired pre- and postsurveys were analyzed. Reported confidence increased in 22 of 23 resuscitation-related items. IMPLICATIONS FOR PRACTICE: Education and simulation programs providing opportunities to experience high-risk, low-frequency VLBW delivery situations can assist in identifying areas for improvement and may improve team member confidence. IMPLICATIONS FOR RESEARCH: Additional research is needed to assess whether results would be similar if this program were provided at all levels of neonatal care throughout the healthcare system.
Subject(s)
Delivery Rooms , Resuscitation , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Pregnancy , Reference StandardsABSTRACT
PURPOSE: The purposes of this study were to examine nurses' perception of feeding temperature practices and to compare the nurses' temperature estimation with the measured temperature of milk at the time of delivery to the infant. DESIGN: A descriptive exploratory study was conducted in 3 level III neonatal intensive care units (NICUs). SUBJECTS: A convenience sample of nurses from 3 level III NICUs in the Midwest. In addition, temperatures from bottle/syringe samples of formula/breast milk were measured and recorded. METHODS: The Feeding Practices and Temperature Survey, a 10-item survey measuring nurses' perception of the effect of feeding temperature on infant condition, was distributed to subjects. Afterward for select feedings, researchers recorded the type of milk, delivery method, nurses' estimated temperature of the milk, and the measured infrared temperature of milk just before feeding delivery. To compare perception with actual practice patterns, the measured milk temperature was compared with the nurses' estimated temperature, standard room temperature, and body temperature using descriptive statistics of the survey responses and t test comparisons. MAIN OUTCOME MEASURES/PRINCIPAL RESULTS: A total of 141 surveys were analyzed. More than 50% of respondents reported feeding temperature as clinically very significant. A range of 35.5°C to 37.2°C was reported as the ideal temperature of breast milk at delivery. Recordings of 419 temperatures were used for analysis. Measured milk temperature just before feeding ranged from 22°C to 46.4°C. The mean measured temperatures were 31.0°C (SD = 2.8°C) for warmed milk in a bottle and 30.5°C (SD = 2.5°C) for milk warmed in a syringe. The measured milk temperature and the nurse-estimated temperature were significantly lower than body temperature (P = 0.000) and significantly higher than room temperature (P = 0.000). CONCLUSION: Current warming methods yield wide variation in milk temperature. Nurses' estimation of milk temperature was not consistent with measured temperature at the time of delivery. Future research is needed to establish guidelines for feeding temperature standardization assisting nurses to enhance evidence-based feeding practices.
