Thursday December 18th 2014

Collaborating to improve infant care

To improve the nursing care for late preterm infants, the state of Louisiana and the Institute for Healthcare Improvement (IHI) this year will begin using a toolkit created by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).

The toolkit will be shared with all Medicaid-supported birthing hospitals throughout the state. IHI has expertise in helping health professionals use quality improvement techniques to ensure best practices are reliably implemented to reach every mother and baby, every time.

Late preterm infants (those born between 34- and 36-completed weeks of gestation) represent the majority of preterm births and 8.7 percent of all births in the United States. These infants experience more medical complications, such as respiratory distress, hypothermia, hypoglycemia, hyperbilirubinemia, sepsis and feeding difficulties, than full-term babies.

As a result of these medical complications, late preterm infants on average have longer hospital stays and more frequent and longer re-hospitalizations during the first few years of life.  Understanding the unique health care needs of late preterm infants is a priority for birthing hospitals and health care providers to improve long-term health outcomes and prevent hospital re-admissions.

An estimated 70 percent of births in Louisiana are paid by Medicaid at about 60 birthing hospitals statewide.  Louisiana will be using the toolkit in these hospitals to assess and improve care for these vulnerable late preterm infants during a two-year quality improvement initiative.  The toolkit components will also be used to improve the outcomes of early term infants (those infants born between 37 and 39 weeks of gestation).

“A surprising number of babies are born at late preterm age with resulting health complications,” said Secretary of the Louisiana Department of Health and Hospitals Kathy Kliebert. “We’re working to improve care and reduce associated costs using AWHONN’s Late Preterm Infant Toolkit. These resources will be shared across the state as part of an important quality improvement initiative.  The AWHONN toolkit is another way DHH is trying to support pregnant women and ensure that healthy babies are born in Louisiana.”

Clinicians can tailor AWHONN’s Assessment and Care of the Late Preterm Infant Implementation Toolkit to their needs for improving patient outcomes, reducing known risks associated with late preterm and early term births, and potentially saving time, administrative and clinical costs.  The hospitals participating in the initiative will gain access to ready-to-use, customizable tools, nursing care process maps, spreadsheets, instruction guides, webinars and strategies for tracking outcomes for these infants.

The toolkit was designed to support the implementation of recommended and standardized nursing care practices for six known risk factors.  These nursing care practice recommendations are outlined in AWHONN’s Assessment and Care of the Late Preterm Infant: Evidence-Based Practice Guideline.  The toolkit includes resources for guiding a staff team through a quality improvement process starting with the initial baseline assessment, ongoing phases of data collection and monitoring.

“Improving care for late preterm and early term infants throughout Louisiana supports AWHONN’s top priorities,” said Catherine Ivory, PhD, RNC-OB, president of AWHONN, an organizational affiliate of the American Nurses Association, and also a Tennessee Nurses Association member. “The toolkit is designed to support hospital leaders’ efforts to advance nursing care in order to improve outcomes, facilitate the transition from hospital to home, and reduce the overall costs of care for late preterm and early term at-risk infants.”

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