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Improving neonatal admission temperature following introduction of a workshop simulation and a new practice guideline

Presented at the Neonatal Society 2010 Spring Meeting.

Mat-Ali E, Birahinduka D

Neonatal Unit, Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UW, London, UK

Background: The mechanism of temperature regulation in preterm babies is relatively immature. They are also less likely to benefit from skin to skin contact to maintain body temperature (1). A core body temperature below 36.4°C (97.5°F) in neonates has been correlated with increased mortality and poor brain and somatic growth (2,5,6). It is well documented how to provide the optimal conditions at birth which maintain normothermia. However, barriers to achieving the intended outcome may include staff behaviour, resistance to change and lack of guidelines.

Aim: The aim of this workshop simulation was to improve admission temperature to neonatal unit, by raising staff awareness of best practice and to teach the technique of improving and maintaining optimal neonatal temperature in the delivery room.

Methods: A new and improved practice was initiated in October 2006. The technique used to maintain optimal admission temperature was based on the work by Lyon et al (3). A new guideline on thermal care at birth (4) was designed and training workshops for medical staff, nurses and midwives were set up on a weekly rolling system. At the end of each workshop there was debriefing on the exercise. Further debriefing also took place at Neonatal Grand Rounds to reflect on individual resuscitation, particularly where the desired admission temperature had not been achieved. Areas for improvement were noted for future practice. Admission temperatures before and after the commencement of simulation training workshops were analysed by examining the admission register and the Standardised Electronic Neonatal Database (SEND).

Results: Our analysis showed that there was a statistically significant increase in the mean admission temperature from 2005 to 2006 (mean 35.6°C vs 36.1°C, p<0.03, unpaired student t-test). Following training workshops the mean admission temperature significantly increased in 2007 compared to 2006 (2006 vs 2007, 36.1°C vs 37.0°C, p<0.0005, unpaired student t-test).

Improving neonatal admission temperature following introduction of a workshop simulation and a new practice guideline

Conclusion: Although the technique published by Lyons et al showed improved outcomes, no improvement was seen at our neonatal unit. Following workshop simulation, a significant improvement was achieved in admission temperature. This shows that good thermal control at resuscitation can be achieved by regular training of medical, nursing and midwifery staff. This should be supported with local guidelines on thermal control. This is an example of how simulation training may improve patient care and clinical outcomes.

References
1. Fransson A-F, Karlsson H, Nilsson K. Archives of Disease in Childhood – Fetal and Neonatal Edition 2005;90:F500-F504
2. Baumgart S. Temperature regulation of the premature infant. In: Taeusch HW, Ballard RA, eds. Avery’s Diseases of the newborn. 7th ed. Philadelphia: Saunders, 1998:367
3. Lyon, AJ et al. Arch.Dis. Child. Fetal Neonatal ED 2004; 89: F93
4. Intranet, Northwick Park Hospital (http://195.104.58.60/documentstorefiles/TemperatureControlGuidelinesDecember2006.doc)
5. Costeloe K, Hennessy E, Gibson AT, et al. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000;196:659–71
6. CESDI Project 27/28. (http://www.cemach.org.uk/publications/p2728/mainreport.pdf

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