Nursing Annual Report - 2015

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2015 MWHC Nursing Annual Report

 About Us  2015 MWHC Nursing Annual Report

2015 MWHC Nursing Annual Report

Nurses Leading The Way

Welcome to Mary Washington Healthcare Nursing Annual
Report

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About Us | Mary Washington Healthcare

Letter From The Senior Vice President & Chief Nursing Officer

Eileen Dohmann, MBA, BSN, RN, NEA-BC

Nursing Accomplishments
Articles

Excellent
Compassionate
Healthcare
Always

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About Us | Mary Washington Healthcare

2015 MWHC Nursing
Annual Report

Welcome Letter

Articles 

Nursing At MWHC

Accomplishments 

Overview

Nursing Councils

What Can We Help 
You Find?

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LOCATIONS

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2300 Fall Hill Avenue
1001 Sam Perry Blvd


Fredericksburg, VA 22401 Fredericksburg, VA 22401

Stafford Hospital
101 Hospital Center Blvd


Stafford, VA 22554

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Vendors

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Welcome Letter

 About Us  2015 MWHC Nursing Annual Report  Welcome Letter

Welcome Letter

August 19, 2015 was a very special day for MWH, as we received notification
of our Magnet
redesignation. This was a proud moment for MWH nurses, recognizing
their commitment to
excellence in their nursing practice and highest quality
of care for their patients. Their
commitment is unwavering, whether during
times of high census, complex patient care needs
and/or staffing needs.


The challenge of achieving Magnet redesignation is surpassed by the challenge
to maintain
it. We now focus our attention on nurse engagement, falls
prevention, patient satisfaction and
the other nurse sensitive indicators
(eg., HAPU, CAUTI, CLABSI).


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Welcome Letters - Mary Washington Healthcare

Each year, MWHC nurses achieve great things. In 2016, we have already
celebrated MWHC
nurses’ focus on professional development. Over
55% of our bedside nurses are prepared at
the BSN level (up from less
than 40% four years ago). Our Advancing Clinical Excellence
professional
development/advancement model recognized our first 18 nurses to pursue
advancement from Level II to Level III.


In 2016, MWHC nurses, again, have the opportunity to commit to professional
practice
decision-making. With our redesigned Shared Governance structure,
launching in March
2016, MWHC nurses will ensure their role in clinical
practice and quality care decisions is
strong, innovative, collaborative
and evidence-based. (I am especially excited to watch our
Night Shift Council.)


MWHC nurses RCARING… ALWAYS! Thank you for all you do. I am PROUD
to be a
MWHC Nurse.
Eileen Dohmann

MBA, BSN, RN, NEA-BC

Senior Vice President &

Chief Nursing Officer

M​ ary Washington Healthcare

2015 MWHC Nursing

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
Annual Report

Welcome Letter
Articles
Nursing At MWHC
Accomplishments
Overview
Nursing Councils

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General Inquiries:
540.741.1404
Mary Washington Hospital:
540.741.1100

Stafford Hospital:
540.741.9000

LOCATIONS

Mary Washington Healthcare Mary Washington Hospital
2300 Fall Hill Avenue
1001 Sam Perry Blvd


Fredericksburg, VA 22401 Fredericksburg, VA 22401

Stafford Hospital
101 Hospital Center Blvd


Stafford, VA 22554

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Magnet Redesignation | Mary Washington Healthcare

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Magnet Redesignation

 About Us  2015 MWHC Nursing Annual Report  Articles  Magnet Rede…

Magnet Redesignation

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Magnet Redesignation | Mary Washington Healthcare

On August 19, 2016, Mary Washington Hospital received “The Call”
from the Magnet
Commission. Mary Washington Hospital nurses had achieved
ReDesignation as a
Magnet Facility. According to Dr. Donna Havens, chairwoman
of the American
Nurses Credentialing Center Magnet Commission, who delivered
the news during
the phone call broadcast to those present at the ceremony,
the decision to continue
Mary Washington Hospital’s designation
was unanimous among Commission
members.

MWHC’s Chief Nursing Officer, Eileen Dohmann MBA BSN RN NEA-BC agreed
that
the recognition was well-earned by the hospital’s dedicated
nurses. “We do
everything we can, every day, to make sure patients
have a great experience with
us, always.” Initially designated in
2009, Mary Washington Hospital nurses have
worked hard to sustain a culture
of the highest quality patient care and professional
standards in partnership
and with the support of our Medical staff, Associates, and
Volunteers.


The Magnet Recognition Program disseminates successful nursing practices
and
strategies and honors healthcare organizations who meet its stringent
standards. It
is recognized as the gold standard of nursing excellence.
Currently only 420 of the
more than 6000, approximately 8%, of U.S. healthcare
organizations have received
this recognition.

2015 MWHC Nursing

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Magnet Redesignation | Mary Washington Healthcare

Annual Report

Welcome Letter

Articles

Magnet Redesignation

Advancing Clinical Excellence

Stafford Hospital PACU Length of Stay

Discharge Follow Up Appointments

MWH NICU Golden Hour

Neonatal Hypoglycemia PI Project

Chemotherapy Safety

Stafford Hospital Endoscopy – Initial and Ongoing
Competency Validation

Compliance with Rapid Response Follow Up at
Stafford Hospital

University of Mary Washington and Mary

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Magnet Redesignation | Mary Washington Healthcare 

Washington Healthcare Collaboration
PICC / Midline Project
Nursing At MWHC
Accomplishments
Overview
Nursing Councils

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Magnet Redesignation | Mary Washington Healthcare

General Inquiries:
540.741.1404
Mary Washington Hospital:
540.741.1100

Stafford Hospital:
540.741.9000

LOCATIONS

Mary Washington Healthcare Mary Washington Hospital
2300 Fall Hill Avenue
1001 Sam Perry Blvd


Fredericksburg, VA 22401 Fredericksburg, VA 22401

Stafford Hospital
101 Hospital Center Blvd


Stafford, VA 22554

Mary Washington Health Alliance
For Associates

For Medical Professionals
Vendors

En Español
Admin Login

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Advancing Clinical Excellence - Mary Washington Healthcare

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Advancing Clinical Excellence

 About Us  2015 MWHC Nursing Annual Report  Articles  Advancing Cl…

Advancing Clinical Excellence

Dr. Mary Jane Bowles DNP RN CCRN CNS-BC - MWH Critical Care
Services

Advancing Clinical Excellence (ACE) is a professional practice model which
is
essential to strengthening nursing professionalism and enhancing job
satisfaction.
ACE is a structure to support nurse empowerment; nurses
who have control of their
practice are linked to high-quality patient outcomes.


A 2010 report from The Institute of Medicine (IOM) calls on nurses to
take a greater role in America’s
increasingly complex health care
system. The American Nurses Association (ANA) commended the IOM

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Advancing Clinical Excellence - Mary Washington Healthcare

for the
report on the nursing profession and acknowledges the need for nurses
to take a leadership role in
all settings to meet the demands of our changing
health care system. The report recommends nursing
focus on the following:
greater use and collection of workforce data, fostering interprofessional
collaboration, improving access to care, promoting nursing leadership
and transforming nursing education.
Mary Washington Healthcare (MWHC)
convened a strategic workgroup to address the components within
the context
of our system.


The revision and development of the ACE was one component of the strategic
workgroup. The goal of
ACE is to provide a path for career promotion for
clinical nurses through mentoring and development. This
nurse led program
promotes a highly educated workforce and drives succession planning. The
program
incorporates Patricia Benner’s novice to expert framework
and is based on the principles of the Magnet
program.


The ACE program is governed by a board of 18 clinical nurses who represent
all areas of the hospital. The
Chief Nursing Officer (CNO), Magnet Program
Director, and Human Resources representatives are non-
voting members.
There are three Nursing Executive Committee (NEC) Liaisons that aid the
Chair of the
Board. Being a member of this Board carries a great deal
of responsibility for those selected will serve as
ambassadors to our
community and adhere to the highest level of ethical standards. Board
members are
appointed by the CNO and to serve the health system is viewed
as a privilege.


Regardless of the service, specialty or practice location, every clinical
nurse who practices at the bedside
across MWHC is an ACE member. Every
clinical registered nurse (RN) has a job description, job code,
and classification
as a Level 1 Novice, Level 2 Competent, Level 3 Advanced, Proficient,
or Level 4 Expert.

LEVEL I


The Level I registered nurse is an entry level Novice nurse who has less
than one year experience at an
acute care facility. Advancement to Level
II is mandatory within one year of hire.


LEVEL II


The Level II professional registered nurse is an experienced clinician
who is Competent to care for
complex patients. The Level II nurse demonstrates
the ability to work collaboratively within the healthcare
team, incorporate
research and continuing education into practice, and participates on the
team to improve
the quality of care in the designated clinical area.


LEVEL III


The Level III registered nurse is an Advanced, Proficient nurse who demonstrates
advanced knowledge
and skill caring for complex care patients and is a
recognized leader in the clinical area. The Level III nurse
takes an active
role in contributing to improved patient outcomes, patient/staff education,
and

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Advancing Clinical Excellence - Mary Washington Healthcare

management.


LEVEL IV


The Level IV registered nurse demonstrates Expert clinical skills and
is regarded as a clinical authority and
resource both within the unit
as well as the hospital. The Level IV nurse is active and contributes
professionally beyond the hospital environment to the community.


The program officially launched in January 2015. Upon completion of our
new graduate nurse residency
program, we celebrate their advancement from
Level I to Level II. The first group, our pioneers in the
program, of
advancees from Level II to Level III completed requirements in late 2015.
Our first group of
Level III RNs include:


Cheryl Bird BSN RNC-NIC – Mary
Washington Hospital Neonatal Intensive
Care Unit

Tricia Boring BSN RN CNOR RNFA –
Mary Washington Hospital Operating
Room

Wendy Brown BSN RNC-NIC – Mary
Washington Hospital Neonatal Intensive Care Unit

Bibiana Cloonan BSN RN CCRN – Stafford Hospital Intensive Care Unit
Tiffany Farrell BSN RN – Mary Washington Hospital Surgical Intensive Care
Unit

JoAnn Karopchinsky MSN RN CMSRN – Mary Washington Hospital 4 South
Denise Katchur BSN RN CCRN – Mary Washington Hospital Surgical
Intensive Care Unit

Rosemarie Kauffman BSN RN – Stafford Hospital Nursing Administration
Tina Keller BSN RN CNOR RNFA – Mary Washington Hospital Operating
Room

Karen Lynne BSN RNC-MNN RNC-LRN – Stafford Hospital Intermediate
Level Nursery

Catherine McAndrews BSN RN CCRN – Mary Washington Hospital Medical

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Advancing Clinical Excellence - Mary Washington Healthcare

Intensive Care Unit
Rosemary Monsell BSN RN OCN – Mary Washington Hospital 4 North
Karen Nunnally BSN RN CPAN – Fredericksburg Ambulatory Surgery Center
Mary Paradis BSN RNC-NIC – Mary Washington Hospital Neonatal Intensive
Care Unit
Angel Patterson BSN RN – Stafford Hospital Endoscopy
Rhonda Shell BSN RN –Stafford Hospital PACU
Yvette Stone MSN RN – Stafford Hospital 4 West
Tonya Watson BSN RN - MWH Cardiac Progressive Care

2015 MWHC Nursing
Annual Report

Welcome Letter

Articles

Magnet Redesignation

Advancing Clinical Excellence

Stafford Hospital PACU Length of Stay

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Advancing Clinical Excellence - Mary Washington Healthcare

Discharge Follow Up Appointments

MWH NICU Golden Hour

Neonatal Hypoglycemia PI Project

Chemotherapy Safety

Stafford Hospital Endoscopy – Initial and Ongoing
Competency Validation

Compliance with Rapid Response Follow Up at
Stafford Hospital

University of Mary Washington and Mary
Washington Healthcare Collaboration

PICC / Midline Project

Nursing At MWHC

Accomplishments 

Overview

Nursing Councils

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General Inquiries:
540.741.1404
Mary Washington Hospital:
540.741.1100

Stafford Hospital:
540.741.9000

LOCATIONS

Mary Washington Healthcare Mary Washington Hospital
2300 Fall Hill Avenue
1001 Sam Perry Blvd


Fredericksburg, VA 22401 Fredericksburg, VA 22401

Stafford Hospital

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Advancing Clinical Excellence - Mary Washington Healthcare

101 Hospital Center Blvd

Stafford, VA 22554

Mary Washington Health Alliance
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For Medical Professionals
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En Español
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Stafford Hospital PACU Length of

Stay

 About Us  2015 MWHC Nursing Annual Report  Articles  Stafford Hos…

Stafford Hospital PACU Length
of Stay

Rhonda Shell, RN BSN

Stafford Hospital PACU

The PI project I focused on was a study to determine barriers to a smooth
transition
for PACU Phase I

patients to Phase II or to floor. My focus was specifically on barriers
which increased

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Stafford Hospital PACU Length of Stay | Virginia Healthcare System

the Length of Stay

{LOS) past the benchmark time of 60 minutes.


Prolonged Phase I PACU stays directly impact the Pillars of Quality, Service
and
Finance. By recognizing common causes and implementing appropriate
action plans
to decrease the LOS, it is likely that the department would
note decreased financial
expenditure, a more streamlined patient flow,
increased patient satisfaction, and a
change in patient flow through Phase
I PACU care.


The staff was involved in discussions about the focus of the study, as
well as the
need for data collection. Data collection was initiated in
Centricity, spanning the time
frame of October 2014 to June

2015 with the results reported in July of 2015.


Out of 477 charts (n), 106 (22.2%) had documented LOS >65minutes. The
top
factors included:

*Data from Stafford Hospital PACU Department, October 2014 -June 2015,
based
on review of 477 patient charts


Data collection has continued with monthly reporting. This process has
allowed
there to be a correlation between data collected and trends/issues
ongoing within
the hospital. It has also allowed relationships between
various departments to be
recognized. These results are discussed at unit
based Shared Governance

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Stafford Hospital PACU Length of Stay | Virginia Healthcare System

meetings. Data collection has commenced for Phase
II LOS, and will be analyzed as
the results begin to roll in.


The importance of empowering nursing by education cannot be ignored. Several
of
the articles referenced discuss educating staff about American Society
of
Perianesthesia Nurses (ASPAN) standards. We now have staff that are
members of
ASPAN and the unit is receiving professional journals to reference
and educate
ourselves on the latest evidenced based practice on issues
that affect our LOS.
These include post op nausea and vomiting {PONV),
unwanted sedation, and pain
control. Our current PACU protocol is currently
under revision, which further opens
the door to discussion of current
practice versus evidenced based practices with
documented positive outcomes.


We continue to monitor our practice in reference to our top issues for
LOS. It is
exciting to see the numbers beginning to reflect the care we
are taking to improve
our practice. In the first quarter of 2015 our average
LOS was 61minutes. Our fourth
quarter average was 51minutes, with our
yearly average resulting at 55 minutes.
(Data from Dashboard.)

2015 MWHC Nursing
Annual Report

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Stafford Hospital PACU Length of Stay | Virginia Healthcare System

Welcome Letter
Articles
Magnet Redesignation
Advancing Clinical Excellence
Stafford Hospital PACU Length of Stay
Discharge Follow Up Appointments
MWH NICU Golden Hour
Neonatal Hypoglycemia PI Project
Chemotherapy Safety
Stafford Hospital Endoscopy – Initial and Ongoing
Competency Validation
Compliance with Rapid Response Follow Up at
Stafford Hospital
University of Mary Washington and Mary
Washington Healthcare Collaboration

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Stafford Hospital PACU Length of Stay | Virginia Healthcare System 

PICC / Midline Project
Nursing At MWHC
Accomplishments
Overview
Nursing Councils

What Can We Help
You Find?

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Latest Upcoming Read Video Patient
News Events Our Blog Center Forms

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General Inquiries:
540.741.1404
Mary Washington Hospital:
540.741.1100

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Stafford Hospital PACU Length of Stay | Virginia Healthcare System

Stafford Hospital:
540.741.9000

LOCATIONS

Mary Washington Healthcare Mary Washington Hospital
2300 Fall Hill Avenue
1001 Sam Perry Blvd


Fredericksburg, VA 22401 Fredericksburg, VA 22401

Stafford Hospital
101 Hospital Center Blvd


Stafford, VA 22554

Mary Washington Health Alliance
For Associates

For Medical Professionals
Vendors

En Español
Admin Login

Site Map
HIPAA Notice of Privacy Practices
Notice of Non-Discrimination Practices

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Discharge Follow Up Appointments - Mary Washington Healthcare

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Discharge Follow Up Appointments

 About Us  2015 MWHC Nursing Annual Report  Articles  Discharge Fo…

Discharge Follow Up
Appointments

Rosemarie Kauffman BSN RN CMSRN – SH Nursing Administration
Scheduling post-discharge follow-up appointments is critical, but not easy
for
patients and providers. Research has shown that scheduling follow-up
appointments
before a patient is discharged with input and engagement
from patients and
caregivers is one of the most critical elements to a
safe and effective transition.

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Discharge Follow Up Appointments - Mary Washington Healthcare

Our organization has adopted this as best practice, but most of our patients
continue to leave the hospital
without confirmed appointments and many
providers remain frustrated by a highly manual and unreliable
system.
I call this the “discharge follow-up appointment challenge”.

I identified the need to adopt and implement a quality improvement project
to improve compliance with
scheduling follow-up appointment as a way to
contain health care costs and improve patient care. The
Centers for Medicare
and Medicaid Services (CMS) has also proposed that patients receive specific
follow-
up appointments when discharged from hospitals to prevent costly
readmission.

This project involves Quality, Safety, Service, and Finance Pillars of MWHC.

With the help of my Preceptee, we collected data to support the need for
this project. I also presented in-
services, posted huddle messages and
posters to educate the staff on the Inpatient Units at SH starting
July 20, 2015.

Before implementation:

N = 66 (number of patients who had follow-up appointments made before discharge)
D = 162 (number of patients who did not have follow-appointment made)

After implementation and education to the staff:

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Discharge Follow Up Appointments - Mary Washington Healthcare

N = 33 (number of patients who had follow-up appointments made before discharge)

D = 66 (number of patients who did not have follow-appointment made)


Based on my findings, this will be an on-going process because compliance
with
scheduling follow-up appointment is still very low.


The following actions will be taken for improvement:
continue to educate the staff about the follow-up appointment process
get the support from management to assign a dedicated HUC/CNA at least
on
day shift who will manage the front desk
continue to partner with the hospital volunteers
empower the patients and caregivers to be part of the transition process
and
help them understand the importance of follow-up
work with physician practices/providers when requesting appointments to
give
the patients being discharged from the hospital a priority
explore computer systems/web-based applications or IT-enabled scheduling
processes for follow-up appointments that can be shared across the health
system as well as community providers (at least start with the members
of the
Mary Washington Alliance)

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Discharge Follow Up Appointments - Mary Washington Healthcare

PROJECT UPDATES:

Compliance with scheduling Follow-up Appointments before the patients are
discharged has increased to 75% (from 8/23/15 – 11/20/15). Data
was
gathered from the Inpatient Units (ICU, 2WSU, 3WES, 4WCU)
The increase in compliance was attributed to having a dedicated HUC/CNA
on the 3WES unit from Monday – Friday on Day Shift. There is also
a part-
time HUC/CNA on the 4WCU who assumed the role later.

2015 MWHC Nursing
Annual Report

Welcome Letter
Articles
Magnet Redesignation
Advancing Clinical Excellence
Stafford Hospital PACU Length of Stay

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Discharge Follow Up Appointments

MWH NICU Golden Hour

Neonatal Hypoglycemia PI Project

Chemotherapy Safety

Stafford Hospital Endoscopy – Initial and Ongoing
Competency Validation

Compliance with Rapid Response Follow Up at
Stafford Hospital

University of Mary Washington and Mary
Washington Healthcare Collaboration

PICC / Midline Project

Nursing At MWHC

Accomplishments 

Overview

Nursing Councils

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MWH NICU Golden Hour

 About Us  2015 MWHC Nursing Annual Report  Articles  MWH NICU G…

MWH NICU Golden Hour

Suzie Paradis RNC-NIC, MWH Neonatal Intensive Care Unit

The NICU looked at the mortality rate in the United States of Very Low
Birth Weight
(VLBW) neonates (Infants 28 weeks or less gestation) and
found it was 14.6%. (1)
This population of patients has a high incidence
of co-morbidities due to sepsis,
intraventricular hemorrhage, necrotizing
enterocolitis, retinopathy of prematurity and

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MWH NICU Golden Hour | Mary Washington Healthcare

chronic lung disease. The
transition to extrauterine life in the first hour after birth are
critical
for these patients and standardization of this care has the potential
to
improve quality of life and decrease the co- morbidities for these infants.

The goal of the project was to improve outcomes to the VLBW population
and family satisfaction, build an
interdisciplinary team, create a seamless
new practice and potentially to decrease length of stay. The
group reviewed
the literature to determine optimal management interventions which focused
on thermal,
respiratory and nutritional management of the neonate, performed
chart reviews for baseline Pre Golden
Hour data, identiied key team participants,
and reviewed previous practice.
The departments involved in the project included NICU RNs, Labor and Delivery
RNs, Respiratory
Therapists, Neonatal Nurse Practitioners, Neonatologists,
Pharmacist, Biomedical Engineers and Nursing
Leadership. After the literature
review was presented, the group developed tracking documentation forms;
Golden Hour giraffe bed contents, reviewed key roles of participants,
adapted giraffe bed to Golden hour
bed and NICU admission medications
were all placed in one Acudose drawer.
Some of the identified barriers were distance of x-ray staff and equipment
and resistance of team members
to attempt Peripheral IV and lack of technology
for finding IV access. Our next steps are to mitigate those
barriers by
obtaining a xray reader in NICU and work with radiology to have staff
more readily available
Accuvein Machine for NICU and encourage peripheral
IV attempts.
The following graph demonstrates the progress the team made in each segment
of the golden hour care.

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MWH NICU Golden Hour | Mary Washington Healthcare

Performance Improvement Plan

2015 MWHC Nursing
Annual Report

Welcome Letter
Articles
Magnet Redesignation
Advancing Clinical Excellence
Stafford Hospital PACU Length of Stay
Discharge Follow Up Appointments
MWH NICU Golden Hour
Neonatal Hypoglycemia PI Project
Chemotherapy Safety

http://www.marywashingtonhealthcare.com/About-Us/2015-MWHC-Nursing-Annual-Report/Articles/MWH-NICU-Golden-Hour.aspx[1/18/2017 7:16:04 PM]

MWH NICU Golden Hour | Mary Washington Healthcare

Stafford Hospital Endoscopy – Initial and Ongoing
Competency Validation

Compliance with Rapid Response Follow Up at
Stafford Hospital

University of Mary Washington and Mary
Washington Healthcare Collaboration

PICC / Midline Project

Nursing At MWHC

Accomplishments 

Overview

Nursing Councils

What Can We Help
You Find?

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General Inquiries:
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LOCATIONS

Mary Washington Healthcare Mary Washington Hospital
2300 Fall Hill Avenue
1001 Sam Perry Blvd


Fredericksburg, VA 22401 Fredericksburg, VA 22401

Stafford Hospital
101 Hospital Center Blvd


Stafford, VA 22554

Mary Washington Health Alliance
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For Medical Professionals
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En Español
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Neonatal Hypoglycemia PI Project

 About Us  2015 MWHC Nursing Annual Report  Articles  Neonatal Hyp…

Neonatal Hypoglycemia PI
Project

Karen Lynne BSN RNC-MNN RNC-LLN - SH Intermediate Level Nursery

Neonatal Hypoglycemia (NH) is one most common and life threatening issues
neonates face during transition to extrauterine life. (2,3,4,6) The fetus
relies entirely
on maternal supply and placental transfer of glucose,
amino acids, fatty acids
ketones and glycerol for its energy needs. There
is no fetal production of glucose

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Neonatal Hypoglycemia PI Project | Mary Washington Healthcare

and does not normally occur until after
birth. Also, insulin does not cross the
placenta; therefore, the fetus
must secrete its own. After birth, and clamping of the
umbilical cord,
the abrupt cessation of maternal nutrition, with continued neonatal
secretion
of insulin causes a drop in newborn blood glucose. To counteract the
dropping
glucose levels, the infant begins the process of gluconeogenesis (the
conversion of glucose from non- carbohydrates such as glycerol, fatty
acids, lactate
and amino acids) and glycogenolysis (the breakdown of glycogen).
(2,4,5,6) If
feeding is not initiated (enteral intake of glucose), ketone
metabolism will be
stimulated.


This process causes a normal transitional hypoglycemia in the newborn with
glucose
levels falling during the first two hours after delivery, then
stabilizes by four to six
hours of age. Concentrations then rise more
slowly in the next few days to
concentrations similar to those seen in
older children and adults.


Clinically significant NH reflects the imbalance of glucose utilization
and supply. The
authors of several literature reviews have concluded that
there is no consensus
regarding who is at risk, the specific plasma glucose
value for hypoglycemia, what
level and duration might cause neurologic
injury, or optimal management of neonatal
hypoglycemia. Cornblath et al
summarized this lack of consensus:


"Unfortunately, untoward long-term outcomes in infants with one or
two low blood
glucose levels have become the grounds for litigation and
for alleged malpractice,
even though the causative relationship between
the two is tenuous at best... The
definition of clinically significant
hypoglycemia remains one of the most confused
and contentious issues in
contemporary neonatology." (2)


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Neonatal Hypoglycemia PI Project | Mary Washington Healthcare

In response to the confusion, Cornblath et al developed a concept of an
“operational
threshold” for practitioners to use as a guide
in treatment, based on the most current
evidence. The threshold is not
a diagnosis or indicator of future sequelae, but an
indicator of action.
Its focus is on the individual and does not clarify for how long or
how
far below the threshold a value can be before treatment is started. (2)


In March 2011, the American Academy of Pediatrics presented a report to
“provide a
practical guide and algorithm for the screening and subsequent
management of
neonatal hypoglycemia.” (1) According to the guidelines,
infants at highest risk for
significant hypoglycemia are SGA and LGA infants,
those born to mothers with
diabetes, or are late-preterm. Routine monitoring
of blood glucose level is
recommend on at risk infants and those who have
clinical manifestations of NH.


On the SH LDRP inpatient unity, hospital policy follows AAP guidelines
for the care
and management of infants in regards to Neonatal Hypoglycemia.
In early 2015, it
came to my attention from our physicians that infants
at risk are not being captured,
and there are others who have not had
monitoring completed by the guidelines. This
Quality Improvement (QI)
Project was meant to improve patient care determining the
reasons at risk
infants have not been monitored according to AAP guidelines.


Data collected showed five main reasons that some of the infants were
falling off the
AAP guidelines fell into five categories: missed maternal
risk factors, algorithm not
started appropriately, missed glucose checks,
glucose checks stopped too early,
and extra glucose checks obtained. Through
a series of staff education (bulletin
board inservice and peer to peer
inservice) and assistance with understanding the
algorithm, we were able
to decreased the percentage of infants missing AAP
guidelines by almost
50%, meeting our primary goals to recognize infants at risk of

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Neonatal Hypoglycemia PI Project | Mary Washington Healthcare

disturbances
in postnatal glucose homeostasis and provide a margin of safety by
early
measures to prevent and treat low concentrations of serum glucose.


References:


1. Amercian Academy of Pediatrics Committee on Fetus and Newborns (2011).
Postnatal glucose homeostasis in LatePreterm and Term Infants. Pediatrics,
127,
575-579


2. Cornblath M, Hawdon J, et al. Controversies Regarding Definition of
Neonatal
Hypoglycemia: Suggested Operational Thresholds. Pediatrics 2000;
105: 11411-
1145


3. Sweet C, Grayson S, Polak M. Management Strategies for Neonatal
Hypoglycemia.
J Pediatr Pharmacol Ther 2013; 18(3): 199-208


4. Pathogenesis, screening, and diagnosis of neonatal hypoglycemia. Retrieved
from: http://www.Uptodate.com


5. Wight N, Marinelli K, and The Academy of Breastfeeding Medicine. ABM
Clinical
Protocol #1: Guidelines for Blood G;ucose Monitoring and Treatment
of
Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014. Breastfeeding
Medicine 2014; 9(4): 173-179


6. Hay W, Tonse R, et al. Knowledge Gaps and Research Needs for Understanding
and Treating Neonatal Hypoglycemia: Workshop Report from Eunice Kennedy
Shriver National Institute of Child Health and Human Development. J Pediatr
2009;

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Neonatal Hypoglycemia PI Project | Mary Washington Healthcare

155(5): 612-617

2015 MWHC Nursing
Annual Report

Welcome Letter
Articles
Magnet Redesignation
Advancing Clinical Excellence
Stafford Hospital PACU Length of Stay
Discharge Follow Up Appointments
MWH NICU Golden Hour
Neonatal Hypoglycemia PI Project
Chemotherapy Safety

http://www.marywashingtonhealthcare.com/...out-Us/2015-MWHC-Nursing-Annual-Report/Articles/Neonatal-Hypoglycemia-PI-Project.aspx[1/18/2017 7:16:12 PM]

Neonatal Hypoglycemia PI Project | Mary Washington Healthcare

Stafford Hospital Endoscopy – Initial and Ongoing
Competency Validation

Compliance with Rapid Response Follow Up at
Stafford Hospital

University of Mary Washington and Mary
Washington Healthcare Collaboration

PICC / Midline Project

Nursing At MWHC

Accomplishments 

Overview

Nursing Councils

What Can We Help
You Find?

http://www.marywashingtonhealthcare.com/...out-Us/2015-MWHC-Nursing-Annual-Report/Articles/Neonatal-Hypoglycemia-PI-Project.aspx[1/18/2017 7:16:12 PM]

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General Inquiries:
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540.741.1100

Stafford Hospital:
540.741.9000

LOCATIONS

Mary Washington Healthcare Mary Washington Hospital
2300 Fall Hill Avenue
1001 Sam Perry Blvd


Fredericksburg, VA 22401 Fredericksburg, VA 22401

Stafford Hospital
101 Hospital Center Blvd


Stafford, VA 22554

Mary Washington Health Alliance
For Associates

For Medical Professionals
Vendors

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