Innovations and Challenges of Implementing a Glucose Gel Toolkit for Neonatal Hypoglycemia.

BACKGROUND: Transient neonatal hypoglycemia occurs most commonly in newborns who are small for gestational age, large for gestational age, infants of diabetic mothers, and late preterm infants. An exact blood glucose value has not been determined for neonatal hypoglycemia, and it is important to note that poor neurologic outcomes can occur if hypoglycemia is left untreated. Interventions that separate mothers and newborns, as well as use of formula to treat hypoglycemia, have the potential to disrupt exclusive breastfeeding. PURPOSE: To determine whether implementation of a toolkit designed to support staff in the adaptation of the practice change for management of newborns at risk for hypoglycemia, that includes 40% glucose gel in an obstetric unit with a level 2 nursery will decrease admissions to the Intermediate Care Nursery, and increase exclusive breastfeeding. METHOD: This descriptive study used a retrospective chart review for pre/postimplementation of the Management of Newborns at Risk for Hypoglycemia Toolkit (Toolkit) using a convenience sample of at-risk newborns in the first 2 days of life to evaluate the proposed outcomes. RESULTS: Following implementation of the Toolkit, at-risk newborns had a clinically but not statistically significant 6.5% increase in exclusive breastfeeding and a clinically but not statistically significant 5% decrease in admissions to the Intermediate Care Nursery. IMPLICATIONS FOR PRACTICE: The Toolkit was designed for ease of staff use and to improve outcomes for the at-risk newborn. IMPLICATIONS FOR RESEARCH: Future research includes replication at other level 2 and level 1 obstetric centers and investigation into the number of 40% glucose gel doses that can safely be administered.

Using High-Fidelity Simulation and Video-Assisted Debriefing to Enhance Obstetrical Hemorrhage Mock Code Training.

The purpose of this descriptive, one-group posttest study was to explore the nursing staff's perception of the benefits of using high-fidelity simulation during mandated obstetrical hemorrhage mock code training. In addition, the use of video-assisted debriefing was used to enhance the nursing staff's evaluation of their communication and teamwork processes during a simulated obstetrical crisis. The convenience sample of 84 members of the nursing staff consented to completing data collection forms and being videotaped during the simulation. Quantitative results for the postsimulation survey showed that 93% of participants agreed or totally agreed that the use of SimMan made the simulation more realistic and enhanced learning and that debriefing and the use of videotaped playback improved their evaluation of team communication. Participants derived greatest benefit from reviewing their performance on videotape and discussing it during postsimulation debriefing. Simulation with video-assisted debriefing offers hospital educators the ability to evaluate team processes and offer support to improve teamwork with the ultimate goal of improving patient outcomes during obstetrical hemorrhage.