A Project to Implement Use of 40% Dextrose Gel for Transient Neonatal Hypoglycemia.

OBJECTIVE: To examine the effect of oral dextrose gel and oral feedings on newborns' blood sugar homeostasis in the first day of life in an effort to decrease transfers to the NICU. DESIGN: Evidence-based practice project. SETTING/LOCAL PROBLEM: Obstetric service at a large hospital in northeast Ohio with approximately 5,300 births annually. Neonates who experienced hypoglycemia were often transferred to the NICU for management if treatment measures failed, thereby increasing the cost of care and separating mothers from their newborns. During 2018, there were 54 neonates transferred to the NICU for hypoglycemia. PARTICIPANTS: Pediatricians, neonatologists, neonatal nurse practitioners, clinical nurse specialists, managers, educators, and registered nurses. INTERVENTION/MEASUREMENTS: An interdisciplinary task force created a nurse-driven protocol and associated order set and also created and provided interdisciplinary education to all involved caregivers using a multimodal approach. Neonates' charts were audited for the time period of April 2019 to April 2020 to evaluate participants' compliance with the prescribed practice changes. RESULTS: The number of neonates who qualified for blood glucose testing per the new protocol totaled 1,369. Of these, 188 (14%) met criteria for and were treated with 40% dextrose gel. Treatment with 40% dextrose gel was unsuccessful for 25 neonates, who were then transferred to the NICU. This is 29 fewer than were transferred in 2018. CONCLUSION: The use of oral dextrose gel and oral feedings was associated with a decrease in the number of newborns transferred to a higher level of care for treatment of hypoglycemia.

Integration and Standardization of Clinical Nurse Specialists in a Multihospital System: Exemplars in Practice.

PURPOSES/OBJECTIVES: In 2013, our multihospital system began the process to integrate and standardize clinical nurse specialist (CNS) practice. The goal was to standardize work and to increase collaboration as part of one system. DESCRIPTION OF THE PROJECT/PROGRAM: An overall job description was established to provide a framework inclusive of the broad areas of practice. Clinical nurse specialists were positioned to support medical-surgical, critical care, or women and children's services offered at community-based hospitals. Main campus and community-based CNSs led significant system integration efforts such as the standardization of nursing policies and procedures across the health system. System CNSs were created to address the needs of specialties common to all hospitals. As an example, a system CNS collaborated with the main campus and community-based CNSs to improve the delirium screening process. OUTCOME: Clinical nurse specialists across the system have been integrated into a single team and report to 1 central director. Efforts to leverage expertise included the creation of a CNS-led practice council, increased communication via regular departmental meetings, and the sharing of resources using electronic platforms. There is now a CNS at hospitals that previously did not have one. The group values the structure and opportunities it provides as evidenced by favorable engagement surveys. CONCLUSION: Our integration efforts improved collaboration and could be modified to benefit other care settings.

Staff Perceptions of Decision-Making in a Shared Governance Culture.

OBJECTIVE: To evaluate differences in the shared decision-making perceptions of clinical nurses between initial implementation of a shared governance model and perceptions 3 years later after the model has matured. BACKGROUND: Shared decision-making empowers nurses to have a voice in their practice and supports engagement and retention. METHODS: A prospective, 2-group comparative design was conducted using the Index of Professional Nursing Governance, a validated, reliable tool. After comparing data univariately, a multivariable linear regression model was used to evaluate the impact of nurse characteristics on shared decision-making responses. RESULTS: Mean overall shared decision-making score (P = .23) and domain scores (P values between .055 and .63) did not increase in 2015 compared with 2012. After adjusting for differences in nurse characteristics between groups, overall score (P = .017) and 3 of 6 domain scores improved: professional control of work, structures for decisions and access to information (all P values between .005 and .031). CONCLUSION: As shared governance became established, shared decision-making scores increased.

Use of sleep studies in the neonatal intensive care unit.

Although early hospital discharge of infants can be both cost-effective and better for developmental care and parent-infant bonding, neonatal caregivers need to ensure infant safety. One of the concerns of early discharge is the risk that premature babies may continue to have apnea, bradycardia, and oxygen desaturation after discharge and that these events can be serious enough to increase morbidity and mortality. The discharging provider bears the responsibility of assessing each infant's risk for persistent apnea and providing the care and monitoring appropriate for his presumed risk level. Presently there is no universally accepted testing method that can accurately predict which infants will experience significant apnea. Neonatal sleep studies are one of the objective methods being evaluated to identify infants at risk for persistent apnea. This article addresses arguments for and against the use of sleep studies to determine the risk of apnea in neonates about to be discharged, types of sleep studies and what they test, and how sleep studies can be useful in determining infant care.