A Quality Improvement Intervention to Decrease Hypothermia in the Delivery Room Using a Checklist

Abstract

Introduction: Premature babies are at increased risk of hypothermia, core body temperature <97°F. Delivery room environment may contribute and lead to complications. The objective was to reduce hypothermia in babies <32 weeks of gestation in the delivery room to <40% using a checklist and sustain it for 6 months. Methods: We created a delivery room checklist in 2012. Chart review established a baseline rate of hypothermia (<97°F). The team analyzed the checklist’s effect on hypothermia from 2012 to 2018 and utilized numerous interventions to maintain compliance. Chi-square test and Fisher’s exact test analyzed hypothermia and hyperthermia as a balancing measure. All calculations performed in SAS 9.3. Results: The checklist reduced hypothermia from a baseline of 50% in 2011 (n = 104) to 33% in 2012 (n = 106). In 2013, the proportion of hypothermia slightly increased to 36% (n = 81). The year 2014 brought larger drift, and proportion of hypothermia increased to 44% (n = 117). In 2015, we reinforced the use of the checklist and proportion of hypothermia improved to 36% (n = 99). Further interventions through 2018 decreased hypothermia further to 14% to achieve statistical significance. Conclusions: A checklist is a simple tool that may yield beneficial changes in practice and helped to decrease the proportion of neonatal hypothermia.

WITHDRAWN: Quality Improvement for Neonatal Resuscitation and Delivery Room Care

“…Multiple reports describe efforts by single NICUs and collaboratives to reduce hypothermia through structured QI methods 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 . Outcome measures primarily examined temperature on NICU admission, with some reports also examining other morbidities.…”

“…Other interventions included pre-delivery team preparation, staff education, improved storage of necessary equipment near point of care, having a dedicated OR for all preterm deliveries, measuring infant's temperature during DR stabilization, and having staff designated to temperature control. Approaches to improvement and standardization included checklists, guidelines, or thermoregulatory bundles 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 . Some centers used a stepwise approach to implement these same interventions 10 , 11 , 20 .…”

Real-Time Safety Audits of Neonatal Delivery Room Resuscitation Areas: Are We Sufficiently Prepared?

“…23 In addition, applying checklists at the time of delivery can have important clinical repercussions such as the reduction of hypothermia in newborns after birth. 24,25 Therefore, we believe that these lists should be used routinely in the preparation of materials for members of the resuscitation team before CPR. Indeed, in our work, 11.5% of minor rectifiable defects were detected by performing a systematic check, like those provided on the checklist, prior to carrying Abbreviations: FiO 2 , inspired oxygen fraction; PEEP, positive end expiratory pressure; PIP, maximum inspiration pressure.…”

A Quality Initiative for Reducing Postoperative Hypothermia for Neonatal Intensive Care Unit Surgical Patients

“…Checklists have been used successfully in the delivery room to decrease hypothermic temperatures for premature infants being admitted to the NICU. 14 Engorn et al 15 showed that the use of a checklist helped reduce postoperative hypothermia in NICU patients. Furthermore, the Children’s Hospitals Neonatal Consortium STEPP-IN initiative published results showing that a multi-institutional quality improvement project reduced postoperative hypothermia from 20.3% to 10.5%.…”