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QI 101

Step 1: What are we trying to accomplish?

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Goal of QI:

  • Model for Improvement that attempts to provide a framework for developing, testing and implementing changes that lead to improvement

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  • Based on 3 Questions:
    • What are we trying to accomplish?
    • How will we know that change is an improvement?
    • What changes can we make that will result in improvement?

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Newborn Hypoglycemia Care Goals

Keep the Infant at the Center of Our Efforts

What does this infant/family need to thrive?

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  • Keep infants warm/fed (Normoglycemia)
  • Identify and support family feeding goals
  • Keep families together
  • Transfer to NICU for intermediate level care
  • Validate care on ALL units: Birthing Center (LD, PP) & NICU

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Step 1: What are we trying to accomplish?

  • Reduce burden on nursing staff?
  • Reduce stress for families?
  • Reduce supplementation?
  • Reduce NICU admissions?

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  • SMART Goal: We will decrease the percent of newborns screened for asymptomatic hypoglycemia who are admitted to the NICU for treatment of hypoglycemia from 5% per year (current) to < 4% per year by December 31 2021.

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Meriter Baseline Data

  • Total Babies born in 2019 = 4818
  • Total number of babies screened for hypoglycemia = 1522 (38%)
    • Expect to screen up to 30% of newborns (vanKempen NEJM 2020)
    • 48.8% of infants admitted to well baby nursery screened (Miren Peds 2018)

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  • 42% of babies screened had one or more low blood sugars (defined as < 40 in first 4 hours of life or < 45 from 4-24 hours of life)
    • Compare to reports that up to 51% of babies < 47 and 19% of babies less than 36 in first 24 hours of life (Harris NEJM et al)

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  • 5% of babies screened were admitted to NICU for hypoglycemia
    • 4.6% of infants in large study in Pediatrics (Miren Peds 2018)

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Outcome Measures

  • Data collection
    • Total number of babies born
    • Total number of babies admitted to NBN
    • % of newborns screened – how many had BS checked
    • % of newborns admitted to the NICU
  • Primary measure
    • NICU admission rates
      • Current 5-6% admission to NICU
      • Goal 3% admission to NICU (Goal reduction of 50%) LeBlanc Pediatrics 2018
  • Secondary measures
    • Newborns who got > 4 doses of gel NOT admitted to NICU
    • Newborns admitted to NICU NOT treated with IV Dextrose
    • Breastfeeding rates at discharge (? Difficult to measure)

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Multiple PDSA Cycles Over Last 3 years

  • PDSA Cycle 1 DHM vs Formula
  • PDSA Cycle 2 Glucometer Comparison
  • PDSA Cycle 3 LPT and LBW supplementation policy
  • PDSA Cycle 4 Policy Revision 8/21
  • PDSA Cycle 5 Temperature Regulation 2/23

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New Protocol 8/21