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IHS Electronic Health Record EHR

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The International Council of Nursing Conference. Yokohama - Japan ... Department of Obstetric & Gynaecology. Tuen Mun Hospital. New Territories West Cluster ... – PowerPoint PPT presentation

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Title: IHS Electronic Health Record EHR


1
The International Council of Nursing Conference
Yokohama ------ Japan
28 May 1 June 2007
2
(Subject)
Department of Obstetric Gynaecology Tuen Mun
Hospital New Territories West Cluster Hospital
Authority Hong Kong Special Administrative
Region China
3
(Subject)
Presenters Ms. Esther Siu (Nurse Specialist) Ms.
Lo Tsui Lam (Registered Nurse Midwife) Ms. Rose
Chan (Nursing Officer)
NTWC, TMH
Date 1st June 2007
4
Prevention of Neonatal Hypothermia in Delivery
Suite
5
Introduction
  • All gestational age newborns at risk of losing
    heat soon after birth

6
Introduction
  • Neonatal hypothermia induced cold stress and
    result in
  • Metabolic rate, leading to O2 consumption
  • Caloric consumption and glycogen stores
  • Development of acidosis due to pulmonary
    vasoconstriction
  • Thermal shock and DIC (in the more serious
    cases), progressing to death

7
WHO
Definition of hypothermia (C)
36.4c ? 36c Mild hypothermia
35.9c ? 32c Moderate hypothermia
Below 32c Severe hypothermia
WHO, 1997
8
Definition of hypothermia in neonates
  • Axilla temperature
  • is the current mode
  • for monitoring babies body temp

9
Operative Definition of Hypothermia in Delivery
Suite
Hypothermia Temp below 36ºC
Moderate hypothermia Temp at 35-35.9ºC
Profound hypothermia Temp less than 35ºC
Optimal temp. range36.837.2 C
10
Background
  • Study results (May July 2001) from
    Paediatricians
  • (TMH) illustrated the prevalence of neonatal
    hypothermia on admission to NNU from Delivery
    Suite
  • 22 moderate hypothermia
  • 1.5 profound hypothermia

11
An alarming data
from 1st May to 5th July 2004
Profound hypothermia
Moderate hypothermia
2004 May - July
2001 May - July
12
What happened between 2001 to 2004?
  • ???
  • Delivery Suite

Fridge
13
Actually in2002 2003 Delivery Suite were
endeavored to manage neonatal thermal regulation
14
  • Tackle the problem of suboptimal
  • ambient temperature in
  • Delivery Suite
  • Standardized and reinforced
  • the practice

15
  • Standard guidelines and protocol on Neonatal
    Thermal Regulation
  • was developed and endorsed by the Consultants of
    the two departments.
  • Periodical audit was conducted to ensure all
    staff to adhere the standard practice protocol.

16
Why still cold ?
Why??
Why????
Why ???
17
Joint Meeting(OG Paed. AM) in July 2004
  • Discussed the Root Causes

18
Root causes
  • Adequate ambient temperature for the births
  • Monitoring
  • Compliance with the protocol guidelines on
    neonatal thermoregulation
  • Space of improvement on practice
  • Discrepancy on procedure of temperature taking
  • Problem on neonatal transportation

19
CQI Program
Objective
  • Reduce the incidence and monitor the prevalence
    of neonatal hypothermia in Delivery Suite

20
Prevent Neonatal Hypothermia
21
Environment
  • Room Temp
  • Incubator Temp
  • Resuscitaire Temp
  • Heater

22
Procedure
  • Reinforce current guideline
  • Change practice in receiving baby inside the
    operating theater
  • Apply evidence based practice
  • Polyethylene occlusive skin wrapping
  • Standardized measurement tool

23
Procedure
  • Reinforced current practice to prevent heat loss
  • Hypothermia should be avoided
  • Placing the infant under a radiant warmer
  • Rapidly drying the skin
  • Removing wet linen immediately
  • Wrapping the infant in pre-warmed blankets
    The International
    Guidelines for Neonatal Resuscitation, 2000

24
Apply Polyethylene Occlusive Skin
Wrapping in Preterm Infants
  • Use of occlusive polyethylene wrap improved
    admission temperatures for infants
  • Bredemeyer, S., et. al , 2005
  • Admission temp significantly ? during
    resuscitation by occlusive wrapping after birth.
  • Vohra, et. al , 1999
  • Bjorklund Hellstrom-Westas, 2000
  • Lyon Stenson 2004

25
Procedure
  • Change practice (mainly in OT)
  • Warm towel / blanket, shawl
  • Receiving baby directly from surgeon

26
Baby wrapped with
Polyethylene sheet in Delivery Suite
  • Criteria
  • 1. lt 36 weeks
  • 2. BW lt 2.5 kg
  • 3. 1st Body Temperature lt 36º c

27
Procedure
  • Standardized measurement tool and procedure with
    neonatal unit on temperature taking

28
Transport
  • Incubator Temp
  • Maintain 37- 37.5c
  • During transferred to Neonatal unit
  • Use of a polyethylene plastic sheet wrapping the
    infant
  • Kattwinkel et al, 1999
  • Vohra et al, 1999
  • Bjorklund and Hellstrom-Westas, 2000
  • Lenclen et al, 2002
  • McCall, et al, 2005

29
Re-establish protocol
  • Baby lt 37 wks
  • Baby templt 36.8c
  • B.W. lt 2.5kg

30
Evaluation
31
Data analysis
  • Overall prevalence of neonatal hypothermia in
    D.S.
  • Overall prevalence of hypothermia amongst
    neonatal admission
  • Compliance rate for application of polyethylene
    occlusive skin wrapping to prevent neonatal
    hypothermia

32
Compare the overall prevalence of neonatal
hypothermia rate in D.S. in the year of 2004
2005
Overall prevalence of hypothermia rate
Year
33
Results
  • No neonatal hypothermia
  • was reported on arrival of postnatal wards during
    the data collection period in
  • 2004 2005

34
Results (Hypothermia rate on NNU admission)
35
Mode of delivery for babies with hypothermia on
NN admission
36
Audit on practice of Polyethylene Occlusive skin
wrapping for newborn in 2005
37
Improvement
  • Overall prevalence of neonatal hypothermia at one
    hour after birth in DS

0.5
0.23
38
Improvement
  • Incidence of hypothermia on Neonatal Admission

18.7
12.8
39
Findings
  • Hypothermia significantly occurred in the
    vulnerable group of newborns on neonatal
    admission.
  • The vulnerable group of sick babies included
    premature (38), LBW (65), suffering
    hypoglycaemia since birth or birth asphyxia.
  • The vulnerable group of babies with C/S birth in
    OT were more easily prone to hypothermia.

40
Other Findings
  • Among the group of hypothermia babies on
    admission to NNU
  • Babies
  • without polyethylene sheet wrapping
  • not compliance with the practice guideline
  • Body temp dropped 1 to 1.5 ºc
  • Babies were transported by an incubator
  • with insufficient temperature (33.5 35.8 ºc)
  • Body temp. dropped 0.3 0.7 ºc

41
Recommendation
Issues to help decreasing the incidence of
hypothermia rate on NN admission included
  • Maintenance of an optimal ambient temperature for
    birthing (delivery room operating
    room) by regular checking and auditing
  • Strictly compliance with the practice protocol
    (both medical and nursing staff)

42
Recommendation
  • Application of evidence based practice
  • (polyethylene occlusive skin wrapping) especially
    for the extreme premature or low birth baby
  • Ensure adequate temperature of pre-warmed
    incubator (at least 37.5 ºc or above) for
    neonatal transport.

43
3rd Phase
  • Collect clinical data for evaluation in 2006
  • Audit on the compliance with protocol

44
Results (Hypothermia rate on NNU admission)
45
Mode of delivery for babies with hypothermia on
NN admission
C/S Caesarean Section, V/D Vaginal Delivery,
BBA Born Before Arrival
46
Audit on practice of Polyethylene occlusive
skin wrapping for newborn in 2005 2006
of compliance rate
47
Conclusion
  • An optimal ambient temperature for delivery
  • An adequate temperature of incubator for
    transportation
  • The application of polyethylene occlusive skin
    wrapping
  • All help the vulnerable small clients
  • to prevent heat loss.

48
Conclusion
  • Continue quality improvement required
    multi-discipline approach.
  • Collaboration among paediatricians,
    obstetricians, nurse midwives with advices from
    anaesthetist, OT NS, ICN and helpfulness from EM
    dept. would help our small vulnerable clients in
    less risk of hypothermia.

49
Whats going on???
  • Keep Continuous improvement!!
  • Our team is endeavored to manage
  • neonatal thermal regulation

50
Acknowledgement
Managerial support
Professional advice
Dr. K.B. Cheung (COS OG) Dr. S.F. Wong
(Consultant OG) Ms. Joan Ip (DOM OG) Dr.
K.T. So (COS PAM) Dr. N.S. Kwong
(Consultant PAM) Ms. Winnie Lee (DOM PAM)
  • Dr. K.K. Lam (COS Anae
    ICU)
  • Infection Control Nurses
  • Ms. Isabel Lee (OT NS)
  • Clinical data collection in NNU
  • Ms. Helen Ng (WM D7)
  • Ms. K M Choi (WM D6)
  • Technical support
  • Dept. of EM TMH

All Midwives in D.S.
51
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