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  • Quality Improvement Article
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A quality improvement initiative to reduce hypothermia in a Baby-Friendly nursery – our story of algorithms, K-cards, and Key cards

Journal of Perinatology volume 41, pages 1760–1768 (2021)Cite this article

Subjects

Abstract

Background

Baby-Friendly hospitals encourage rooming-in newborns with mothers. In our institution, we noticed increased incidence of hypothermia following Baby-Friendly designation. We aimed to reduce the incidence of hypothermia in the mother-baby-unit to <15% and to decrease the rate of isolated hypothermia admissions to the neonatal intensive care unit (NICU) by 20% over two years.

Methods

After a retrospective review of newborns ≥35 weeks gestation in the mother-baby-unit with hypothermia, we implemented multiple interventions such as nursing education, hypothermia algorithm, Kamishibai cards, and Key cards.

Results

Hypothermia incidence in the mother-baby-unit decreased from 20.9 to 14.5% (p < 0.001) and infants requiring NICU admission decreased by 71% (p < 0.001) following all interventions. Apart from nursing education, all interventions led to significant reductions in both outcomes from baseline.

Conclusion

Instituting a hypothermia algorithm and utilizing K-cards and Key cards reduces the incidence of hypothermia in the mother-baby-unit and NICU admissions for isolated hypothermia.

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Fig. 1: Process Map for maintaining newborn thermoregulation and key drivers that influenced the project.
Fig. 2: Hypothermia algorithm.
Fig. 3: Hypothermia cases in MBU.
Fig. 4: NICU admissions for isolated hypothermia.
Fig. 5: Hyperthermic infants in the MBU (balancing measure).

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Acknowledgements

We want to acknowledge all the nurses in the MBU and Mary Lynn Brassil RN the nurse educator, hospitalists, and residents for their support and assistance with the initiative.

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Author notes

  1. These authors contributed equally: Noel Joseph, Tal Dror

Authors and Affiliations

  1. Department of Pediatrics, Le Bonheur Children’s Hospital, Memphis, TN, USA

    Noel Joseph

  2. Department of Pediatrics, NYU Langone Hospital-Long Island, Mineola, NY, USA

    Tal Dror, Eva Takhalova, Ranjith Kamity, Ulka Kothari, Alena Connelly, Nazeeh Hanna & Amrita Nayak

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  1. Noel Joseph
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  2. Tal Dror
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  3. Eva Takhalova
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  4. Ranjith Kamity
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  6. Alena Connelly
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  7. Nazeeh Hanna
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  8. Amrita Nayak
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Contributions

Conceptualization: NJ, TD, AC, AN. Data curation: NJ, TD, ET, AK. Formal analysis: NJ, TD, ET, RK, AN, UK. Investigation: NJ, TD, ET, AK. Visualization: NJ, TD, ET, RK, AN, AC. Supervision: AN, NH. Writing review and editing: NJ, TD, ET, UK, RK, AN.

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Correspondence to Amrita Nayak.

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Joseph, N., Dror, T., Takhalova, E. et al. A quality improvement initiative to reduce hypothermia in a Baby-Friendly nursery – our story of algorithms, K-cards, and Key cards. J Perinatol 41, 1760–1768 (2021). https://doi.org/10.1038/s41372-021-01073-y

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