Quality improvement programme to increase the rate of deferred cord clamping at preterm birth using the Lifestart trolley

Abstract

AimTo increase the documented use of the Lifestart trolley to allow premature infants’ (<32 weeks’ gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.DesignA 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.ResultsDocumented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).Implications and relevanceBy undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.

Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens

“…When evaluating the implementation, training was the main cited facilitator, while team adherence, mainly from other sectors, and lack of knowledge were the most cited barriers. The need for continuous training of the professionals, with the involvement of the multi-professional teams, was also mentioned in other studies as a facilitating component, capable of promoting active participation in processes and avoiding decline of the proposal (10,23,25) .…”

Thermoregulation-Focused Implementation of Delayed Cord Clamping among <34 Weeks' Gestational Age Neonates

“…15 With deliberate QI efforts, the compliance rate of DCC can be up to 73 to 79%, even among very low birth weight neonates. [16][17][18] We increased our DCC compliance rate in preterm neonates up to 57%. Prior to implementation, we identified barriers for DCC and designed an implementation strategy accordingly.…”

‘It must be right, I saw it on TV!’: An observational study of third stage birth practices in popular television programmes

“…We have been unable to find any audits of UK cord clamping practice for term infants in the decade since consultation on 2014 NICE Intrapartum care guidelines, despite being a NICE Quality Standard (QS), and unlike audits in the premature. 24 The CQC should consider requesting NICE QS150 data from health care providers as a possible measure of good quality evidence-based care. One US survey suggests clinicians in practice for over ten years are the least convinced about evidence, and that black babies seem more at risk of too early clamping.…”