Engaging Frontline Providers Prevents Hypothermia and Improves Communication in the Postoperative Neonate.

BACKGROUND: Neonates undergoing surgery are at high risk for perioperative hypothermia. Hypothermia has been associated with increased adverse events. Transfer of care from the operating room (OR) to the neonatal intensive care unit (NICU) adds another layer of risk for this population introducing the potential for miscommunication leading to preventable adverse events. PURPOSE: The aim of this quality improvement initiative is to decrease mean postoperative hypothermia rate and achieve compliance with use of a standardized postoperative hand-off in neonates transferred to the NICU from the OR. METHODS: An interdisciplinary team identified opportunities for heat loss during the perioperative period. The lack of standardized perioperative communication between the NICU and the OR and postoperative communication between neonatology, anesthesiology, surgery, and nursing were noted. Guidelines for maintaining euthermia in the perioperative period and a standardized interdisciplinary postoperative hand-off communication tool were created. FINDINGS/RESULTS: Mean rate for participation in the hand-off process increased from 78.8% to 98.4% during the study period. The mean hypothermia rate improved from 28.6% to 6.3% (P < .0001) and was sustained. IMPLICATIONS FOR PRACTICE: Creating a hypothermia guideline and standardizing temperature monitoring can significantly decrease the rate of postoperative hypothermia in neonates. Standardization of transfer of care from OR to NICU increases consistent communication between the services. IMPLICATIONS FOR RESEARCH: Future research and improvement efforts are needed to optimize the management of surgical neonates through their transfers of care.

Creating a Highly Reliable Neonatal Intensive Care Unit Through Safer Systems of Care.

Neonates requiring intensive care are at high risk for medical errors due to their unique characteristics and high acuity. Designing a safer work environment begins with safe processes. Creating a culture of safety demands the involvement of all organizational levels and an interdisciplinary approach. Adverse events can result from suboptimal communication and lack of a shared mental model. This chapter describes tools to promote better patient safety in the NICU through monitoring adverse events, improving communication and using information technology. Unplanned extubation is an example of a neonatal safety concern that can be reduced by employing quality improvement methodology.

Reducing Incidence of Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is a multifactorial disease that occurs when multiple risk factors and/or stressors overlap, leading to profound inflammation and intestinal injury. Due to its multifactorial nature, there has been much uncertainty in identifying clear strategies for prevention of NEC. Despite these obstacles, the incidence of NEC has gradually been decreasing over the past 10 years, in part due to quality improvement (QI) initiatives to prevent NEC. Current QI strategies primarily target the various predisposing conditions. This article reviews the evidence on which QI interventions to prevent NEC have been based and provides examples of successful QI interventions.

Immune-related, lectin-like receptors are differentially expressed in the myeloid and lymphoid lineages of zebrafish.

The identification of C-type lectin (Group V) natural killer (NK) cell receptors in bony fish has remained elusive. Analyses of the Fugu rubripes genome database failed to identify Group V C-type lectin domains (Zelensky and Gready, BMC Genomics 5:51, 2004) suggesting that bony fish, in general, may lack such receptors. Numerous Group II C-type lectin receptors, which are structurally similar to Group V (NK) receptors, have been characterized in bony fish. By searching the zebrafish genome database we have identified a multi-gene family of Group II immune-related, lectin-like receptors (illrs) whose members possess inhibiting and/or activating signaling motifs typical of Group V NK receptors. Illr genes are differentially expressed in the myeloid and lymphoid lineages, suggesting that they may play important roles in the immune functions of multiple hematopoietic cell lineages.