Since implementation, the percent of babies actively cooled on transport and arriving to the NICU with a temperature <33°C has decreased from 21.15% in 2021 to 11.32% in 2022. The standardization of rectal temperature monitoring and documentation was essential to ensure the data captured was reflective of the actual practice. This session will describe how quality improvement tools and human factors principles were applied in complex care environments to ensure that the temperatures of neonates actively cooled on transport into our hospital were regulated appropriately.
Problem: Neonates will receive therapeutic hypothermia to mitigate sequelae following an acute hypoxic event. These babies can quickly become overcooled, which can lead to skin alterations, fat necrosis, and exacerbation of pulmonary hypertension symptoms. In 2021, 21.15% of babies who were actively cooled on transport had admission core temperatures < 33°C
Measurement: A multidisciplinary team, consisting of NICU providers, transport personnel, nurses, and quality professionals investigated the reasons for low temperatures in babies actively cooled on transport using a process map and fishbone diagram and informed by live time audits and chart review
Analysis: Data from the previous year was compared to the current year on a month-by-month basis using an annotated run chart to identify reasons for any significant changes in the data based on improvement efforts and staff feedback. Data was stratified by rectal or axillary temperature, sending location, and clinical severity
Implementation:
- Standardized rectal temperature monitoring for all babies admitted from transport
- Clarified the appropriate ‘start’ time for data capture
- Linked records of all babies actively cooled on transport with live-time data capture
- Developed standard templates to conduct small-scale root-cause analyses for overcooled babies
- Educated staff on the use of cooling devices
