Big changes for tiny people

 

Texas Health NICUs using Ziploc bags and gel to improve care for babies

You know the saying the biggest things can come in the smallest of packages?

At Texas Health, our nurses are taking that one step further – and serving up some big innovations for our tiniest of patients.

Texas Health Neonatal Infant Care Units have seen a handful of advancements this year that involved some out-of-the-box thinking. And the use of a gel and Ziploc bags.

A group of nurses at Texas Health is leading a program that uses glucose gel to regulate blood sugar in infants, keeping them out of the NICU, which not only benefits the newborn but also provides huge cost savings for parents.

“In the past, if a baby had low blood sugar, then they would most likely be admitted to the NICU which could cost $3,000-4,000 a day,” says Lindsey Cannon, manager of the NICUat Texas Health Fort Worth. “But now we’re using a simple, low-cost intervention which is the glucose gel. It’s typically used for adult diabetic patients but it’s safe for infants up to three doses. It allows the baby to stay with mom in mom’s room instead of coming down to the NICU, and it’s very non-invasive. In the past, we would maybe have to give them an IV to give them dextrose fluids through that, but this way we don’t have to do that. And the best part? It’s about $5.”

In June of 2016, a few nurses from the system attended the Association of Women’s Health, Obstetric and Neonatal Nurses Convention where researcher Catherine Bennett, APN, presented her protocol for using glucose gel to treat neonatal hypoglycemia. Results of her research study, “Implementing a Protocol Using Glucose Gel to Treat Neonatal Hypoglycemia,” showed a 73 percent decrease in admission rates to the NICU for hypoglycemia.

“Our nurses came back to their various units or hospitals and they were very excited about this,” says Stephanie Eidson, clinical education specialist at Texas Health Fort Worth. “We knew this could be something that could be so impactful for moms and babies alike so we began work on a plan to research and implement.”

That implementation rolled out in early 2017.

As of June 2017, all 11 of the wholly owned Texas Health hospitals that deliver babies, are using the glucose gel intervention when medically appropriate for infants

But that’s not the only innovative new idea in Texas Health NICUs this year.

In the NICU at Texas Health Fort Worth, nurses are implementing another groundbreaking program that uses Ziploc® bags to help keep babies warm. Yes, you read that correctly.

Work on this project began four years ago when NICU leaders at Texas Health Fort Worth were reviewing data to improve patient outcomes–specifically with regard to the babies’ admission temperatures. During the course of two years, Canon and Eidson worked with an interdisciplinary team to develop the “Hypothermia Eradication from Admission Temperatures” study.

HEAT focused on delivery-room temperatures to create an optimal environment when the baby arrives. Throughout the study, the team collected data on 430 babies.

From that study, two things became clear: the optimal thermostat setting in the delivery room is 76 degrees Fahrenheit, they needed to use preheated, radiant warmers in the incubators and encasing each baby in a makeshift, one-gallon, Ziploc® freezer bag poncho was ideal.

A hole is cut in the bottom of the bag and forms a makeshift poncho. Babies who need this treatment are then slid into the bag, with their head through the hole, keeping their bodies warm from the shoulders down.

Canon agrees it sounds unorthodox, but the numbers speak for themselves: since implementing this process, the percentage of hypothermic infants admitted to the NICU has decreased from 20 to 10 percent, and the percentage of infants with normal temperatures increased from 50 to 70 percent.

“One of the most important things we can do for babies at delivery is to keep them warm,” says Cannon. “There’s a lot of literature that shows evidence that the use of plastic wrap is beneficial for our tiniest patients, so here at Texas Health Fort Worth, we found what works best for us and our babies.”

Cannon adds that not every baby delivered at Texas Health Fort Worth requires this special treatment, just babies who are born before 32 weeks gestational age or those who are born weighing less than 1500 grams or 3.3 pounds.

Since the practice is relatively new, Eidson says it can be a shocker to parents when they see their newborn donning their plastic poncho, but once the nurses explain the purpose, parents are all on board.

“When possible we educate the parents to be expecting the Ziploc® bag because when we first started it, it was kind of shocking, so we realized we do need to educate our parents before,” she says. “When we explain to them why we are doing it, they are absolutely fine because parents want to do what’s best for their babies.”

Both Eidson and Canon explain that Texas Health understands change and innovation go hand-in-hand, which is why we are always striving to find ground-breaking, well-researched treatment plans that could not only improve patient experience but also help transform medicine.

“We are always looking for evidence-based practices, best of care innovations, standard of care; we don’t just follow the status-quo,” says Eidson. “We want to do what’s best for our babies and their families, so we are always reading literature, working with our physicians, working with our team members to do what’s best for the babies.

So, what’s in store for the future? Eidson spares very few details but says Texas Health never stops aiming at improving patient experience.

“We are always looking for innovations,” she says. “We have a few pilots going on in hospitals with some very exciting innovations. Some innovations that would be less invasive to our patients, and I’m very excited to share those soon.”

Edison and Canon recently were featured on the Texas Health Out Loud podcast, discussing these NICU innovations.

 

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