EP6 Nurses incorporate regulatory and specialty standards/ guidelines into the development and implementation of the care delivery system.
Provide one example, with supporting evidence of nurses incorporating specialty standards/ guidelines into the delivery of care.
NAME OF INITIATIVE
Implementation of Updated Neonatal Resuscitation Program (NRP) Standards
BACKGROUND AND PURPOSE
Specialty Guidelines
NRP is an evidence-based educational program focused on newborn resuscitation for hospital staff that care for newborns at the time of delivery that is jointly sponsored and supported by the American Heart Association (AHA). The guidelines are endorsed by 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. The NRP guidelines were updated in 2011 accordingly. Hospital-based instructors offer the courses in community hospitals as part of a service extended to hospitals by the Regional Outreach Education Program. In many institutions the NRP is conducted to:
- Improve the quality of neonatal resuscitation
- Meet performance expectations or attain hospital privileges or credentialing for staff who attend births or care for newborns
- Serve as a quality management strategy to improve the process and outcome of neonatal resuscitation
- Meet regulatory agency requirements for evidence of an education program that supports competency-based practice on neonatal resuscitation.
Although Pediatric Advanced Life Support (PALS) and Pediatric Education for Prehospital Professionals (PEPP) courses are appropriate for those who participate in resuscitations outside the delivery room, NRP may also be useful to providers who desire in-depth training specific to neonatal resuscitation.
A component of Homestead Hospital’s Professional Practice Model is “Clinical Practice”. One of its tenets is adopting evidence-based practice to achieve the best patient and family outcomes. Additionally, the Care Delivery System depicts the adoption of regulatory standards or guidelines into the care of patients and families. To this effect, the Perinatal department requires nurses from all specialties [Labor and Delivery (L&D) and Mother/Baby Unit (MBU)] to complete the NRP course with a biennial review. The unit also requires newly on boarded nurses to complete the course within 6 months of hire. The department has 2 NRP instructors who provide training to the nurses in the hospital and across the system. It also provides the books at no cost and pays for the education time.
The NRP 6th edition published in 2011 upgraded a recommendation to include the availability of an oxygen blender and pulse oximeter in the delivery room for neonatal use from optional to required. The use of this equipment will reduce excessive tissue oxygenation in preterm babies thus decreasing the incidence of hyper oxygenation-related blindness. The oxygen blender mixes oxygen and compressed air in order to more accurately administer oxygen. The nursing staff is prepared to administer neonatal resuscitation in every delivery although the majority of neonates do not require it. However, in the unlikely event that it is needed because the newborn is not responding to stimulation; has peripheral cyanosis or respiratory compromise, having a readily accessible oxygen blender is very important.
METHODS AND APPROACH
Nurses’ Input
Clinical L&D Nurse Melody Falls, RN, who was also an NRP Instructor since 1990 (EP6 01 Falls NRP Instructor Card), made the initial observation that Homestead Hospital did not have oxygen blenders readily available in the L&D rooms to meet the new evidence-based standard. The blenders were located only in the operating room (OR) and “sick baby” nursery and mounted to the wall. As a result, the baby had to be taken out of the birthing suites and brought to the oxygen set-up instead of the other way around. Falls suggested that oxygen blenders need to be available in every L&D room. In April 2013, she approached Perinatal Services Director Jan Weatherspoon to request the purchase of oxygen blenders. Weatherspoon agreed to proceed with the purchase and budgeted for it in the upcoming fiscal year (2014). (EP6 02 FY 2014 Equipment Budget Justification and Quote) Some clinical nurses made the same comment to Weatherspoon during her roundtable on October 2013 during which she asked the staff for their equipment wish list (EP6 03 Perinatal Roundtable Presentation and Sign-in Sheet) Since she already budgeted for the equipment, she was able to initiate the purchase of 9 blenders when the fiscal year opened in October 2013. Due to an unanticipated delay, the purchase order was approved in January 2014 (EP6 04 Oxygen Blender Purchase Order). Biomed Engineering Specialist Richard Lopez installed them in the neonatal warmers inside the L&D rooms in March 2014. Weatherspoon also bought 2 portable blenders mounted on stands which allowed them to be used in the OR and triage areas.
Incorporating Specialty Standards in the Care Delivery
In anticipation of the oxygen blender installation, Clinical Nurse Educators Nancy Martinez, RN and Katherine Adamson, RN started educating L&D and Nursery nurses on the new NRP standard, the rationale for blended oxygen and the use of the equipment in October 2013. They also certified all respiratory therapists. Weatherspoon communicated the practice change through departmental staff meetings. The nurses incorporated the new standard seamlessly into their practice and the use of oxygen blenders became the standard of care for neonatal resuscitation in all settings.
PARTICIPANTS
Name/Credential |
Title |
Department |
Role |
Melody Falls, RN, RNC-MNN |
Registered Nurse |
Perinatal Services |
Project lead and RN champion in L&D |
Emelia Lugo, RN, CCE |
Registered Nurse |
Perinatal Services |
RN champion in Nursery |
Nancy Martinez, BSN, RN, RNC |
Clinical Nurse Educator |
Perinatal Services |
Conducted in-services on the use of blended oxygen and new equipment |
Katherine Adamson, BSN, RN, RNC |
Clinical Nurse Educator |
Perinatal Services |
Conducted in-services on the use of blended oxygen and new equipment |
Jan Weatherspoon, MSN, RN, NEA-BC |
Director |
Perinatal Services |
Provided fiscal support in the equipment purchase |
Richard Lopez |
Biomed Engineering Specialist |
Biomedical Engineering |
Installed the oxygen blenders |
OUTCOMES
Prior to the purchase of oxygen blenders, Homestead Hospital did not meet the new NRP standards. Once the oxygen blenders were purchased and installed, they became part of normal practice in the care delivery within the department. Incorporating specialty standards into practice promotes patient safety and optimal patient outcomes which resonated well among the Perinatal Services nursing staff as evidenced by an increase in their score from 65% to 85% (above benchmark) on the “materials and equipment” question of the 2014 Employee Engagement survey. (EP6 05 Perinatal Services Employee Engagement Result)
Summary of Attachments/Hyperlinks/Evidences
EP6 01 Falls NRP Instructor Card
EP6 02 FY 2014 Equipment Budget Justification and Quote
EP6 03 Perinatal Roundtable Presentation and Sign-in Sheet
EP6 04 Oxygen Blender Purchase Order
EP6 05 Perinatal Services Employee Engagement Result