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  • Quality Improvement Article
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A quality improvement initiative for neonatal hypoglycemia screening and management in a level III neonatal intensive care unit

Journal of Perinatology volume 43, pages 1321–1329 (2023)Cite this article

Subjects

Abstract

Objective

To bring screening and management of neonatal hypoglycemia in alignment with the 2011 AAP hypoglycemia clinical report

Methods

A multidisciplinary team developed a quality improvement initiative for neonatal hypoglycemia in neonates ≥35 weeks gestational age in a Level III neonatal intensive care unit between July 2020 and December 2021. A key driver diagram identified interventions for plan-do-study-act testing with corresponding measures to implement a hypoglycemia management protocol and improve adherence to AAP guidelines.

Results

Time to first blood glucose measurement increased from 49.8 to 122.7 min of life and time to first enteral feed decreased from 14.2 to 3.6 h of life. Neonates receiving intravenous dextrose decreased from 97.1 to 24.7% and discharge rates as a mother-neonate dyad increased from 35 to 62.4%.

Conclusions

Adherence to the AAP guidelines improved during testing and implementation of a hypoglycemia protocol and was associated with an increased mother-neonate dyad discharge rate.

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Fig. 1: Key driver diagram that shows aim, primary drivers, secondary drivers, and specific changes.
Fig. 2: XmR Charts comparing patient-level measures across baseline, implementation, and sustainment phases.
Fig. 3: P Charts comparing aggregate unit level measures with locking the centerline across transitions from the baseline phase to the implementation phase on 11/2020 and into sustainment phases on 5/2021.
Fig. 4: Bar graph comparing the percentage of neonates by discharge location across the baseline, implementation, and sustainment phases.

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Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Whitley N. Hulse

  2. Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA

    Whitley N. Hulse, Victoria Eickelkamp-Marron, Jessica M. Davidson, Belinda Chan, Carrie Torr, Tara L. DuPont & Peter H. Grubb

  3. University of Utah Hospital, Salt Lake City, UT, USA

    Krista Schulte, Victoria Eickelkamp-Marron & Hannah Redder

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  1. Whitley N. Hulse
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Contributions

WH: Dr. Hulse identified the practice pattern to be the focus of the quality improvement initiative, collected the baseline data, and completed the background research. She led the QI team in the development of the key driver diagram, PDSA intervention phases, created the neonatal hypoglycemia protocol, and disseminated all information to participating groups. Dr. Hulse completed the statistical analysis and wrote the manuscript. KS, VEM, HR: Each individual represents a key stakeholder from nursing leadership, nurse practitioners, and nursing. They attended monthly meetings to develop the key driver diagram, design PDSA cycle interventions, disseminate information, provided feedback on dissemination techniques, and provided guidance to their respective group when questions arose. Each author edited and provided feedback on the manuscript. JD, BC, CT, TD: These physicians provided mentorship and guidance throughout the planning and implementation stages of the project at weekly meetings. Each author edited and provided feedback on the manuscript. PG: Dr. Grubb is the senior mentor on this project. He met weekly with Dr. Hulse to help guide the development, implementation, and evaluation of the project. He assisted in the statistical analysis of the data and provided edits and feedback on the manuscript.

Corresponding author

Correspondence to Whitley N. Hulse.

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Hulse, W.N., Schulte, K., Eickelkamp-Marron, V. et al. A quality improvement initiative for neonatal hypoglycemia screening and management in a level III neonatal intensive care unit. J Perinatol 43, 1321–1329 (2023). https://doi.org/10.1038/s41372-023-01740-2

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