Standardized Approach to the Golden Hour: A Program Evaluation

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Premature, low birthweight infants are at increased risk of complications. Hypothermia upon admission to the Neonatal Intensive Care Unit (NICU) after delivery increases morbidity and mortality in this population. The Golden Hour is defined as the first 60 minutes of life, during which interventions and staff behaviors impact neonatal outcomes. This program evaluation assessed the effectiveness of a standardized Golden Hour process program change in a level III NICU. Methods: The gap analysis performed by the multidisciplinary team identified a need to address role clarification to improve hypothermia. A job instruction breakdown tool (JIBT) was created to guide the multidisciplinary team to provide a standardized approach. The admission body temperatures of low birth weight (LBW) infants were measured before and after a program change. Participants were organized into three groups: infants born in the seven-month period before the program change, infants born in the first six months after the program change, and infants born during months 7-12 after the program change. Data was analyzed using ANOVA repeated measures test. Results: 90 infants were included in the retrospective chart reviewed. Results showed an improvement of euthermia upon NICU admission from a baseline of 63% (n=35) during the 7 months prior to the program change to 82% (n=33) during months 1-6 months after the change and 77% (n=22) during months 7-12. While results were not statistically significant, there was an improvement towards euthermia in the post-program change group, a clinically significant finding. Discussion: Hypothermia in the Golden Hour among infants weighing ≤1500 grams places them at greater risk for morbidity and mortality as compared to euthermic counterparts. Utilizing an evidenced-based process improvement measure to clarify standardized roles improves admission temperatures from delivery to the NICU. Stakeholder buy-in was a key step in garnering staff engagement.

DNP project
Golden Hour