Oral Themed Presentation
When critically unwell or extremely premature babies are admitted to Neonatal Care at Middlemore Hospital the admission process is a particularly stressful time for staff, and the family or whaanau of admitted babies. The neonatal ‘golden hour’, the first hour after birth, is based on a trauma and emergency medicine concept where the first 60 minutes after the incident directly impact on patient outcomes. This time period requires health care professionals to be organised and efficient in their actions to ensure that stabilising and lifesaving monitoring and intervention is undertaken in a timely manner.
In our observations of the admission process, and through staff feedback, we have identified that to enhance the coordination of care during the 'golden hour', staff need increased support understanding their roles and responsibilities for the admission process. Within Neonatal Care at Middlemore Hospital, the majority of nursing staff are novice rather than expert. Further, admission team compositions differ from shift to shift and therefore a streamlined approach around complex admissions was necessary. In response to staff needs for clarity of roles and responsibilities, a lanyard was designed for staff to wear. Each of the six lanyards clearly states a role to be undertaken during that admission and on the reverse a list of specific tasks and responsibilities associated with that role. The colours of the lanyards also align with the colours of the equipment pockets in the neonatal emergency grab bag, reinforcing learning and ease of coordination. With the introduction of lanyards around complex admissions, roles are able to be predetermined prior to events with associated responsibilities of that role clearly outlined.
During a pilot period lanyards were introduced for every admission and while their use was sporadic, the admissions that they were utilised patient care appeared to be optimised. This research is an opportunity to more robustly determine outcomes of lanyard use.
We designed a quasi-experimental study aimed at improving compliance with recommended best practice care using Golden Hour principles in Neonatal Care, and increasing nurse confidence for care coordination during the 'golden hour'. The research also seeks to explore what impact the introduction of lanyard use has on health outcomes for babies. For a period of 3-4 months all staff responsible for the admission of infants to Neonatal Care <30 weeks gestation or >30 weeks gestation requiring central lines will wear and use the admission lanyards earlier described. This is a mixed methods approach which uses: semi-structured interviews and surveying of healthcare professionals to assess nurse perceptions of lanyard use and confidence during the golden hour, and comparison of newborn health outcomes (hypothermia and body temperature, severe adverse events (e.g. death), chronic lung disease in intraventricular haemorrhage IVH) across retrospective and prospective cohorts. Time to stabilisation will be measured by time to intravenous nutrition and implementation of developmental care practices.
Pending research findings, the information in this study will be used to create an education and support package for the implementation of the lanyards into daily practice (if indicated in research findings). Currently we are 3 months into the recruitment period and have a total of 24 admissions have been completed using the lanyards. By IPSSW 2019 the research would have concluded with results available.