A Quality Improvement Initiative To Improve The Admission Temperature Of Neonates In The Transition Nursery.

Introduction: Temperature measurement and thermoregulation are important components of newborn care. The World Health Organization (WHO) has released a set of 10 procedures, including a warm chain, to address the global burden of hypothermia. 1The WHO defines neonatal hypothermia as an axillary temperature below 36.5 °C among newborns aged below 28 days. 2A direct relationship between the degree of hypothermia and the risk of infant mortality has been postulated in the studies. 3-5 For every 1° drop in the body temperature below 36.5 °C, studies have shown an increase in the risk of mortality in low-birthweight infants by 28%. 3 Data on hypothermia in late-preterm and term babies is limited, even in developed countries. 6

In our hospital, there is a designated area for babies who have undergone caesarean sections. This area serves as a transition zone until the mother is transferred to the postoperative room or ward. When the babies arrive in the transition nursery, their temperatures will be measured, and they will be placed under a radiant warmer with pulse oximeter monitoring. Once the mother is ready, direct breastfeeding will be started.

During the temperature audit of newborn babies admitted to the transition nursery, the mean temperature upon admission to the transition nursery was 35.5 C. This prompted us to initiate the quality improvement project to improve admission temperature in the transition nursery.

 Aim:

To improve the admission temperature of Late preterm and Term babies admitted to Transition nursey.

Material & methods

**(i)**Study area: Transition Nursery, Manipal Hospital, Old Airport Road, Bengaluru.

 (ii)Study setting: Manipal Hospital, Old Airport Road, Bengaluru.

**(iii)**Study design: Prospective study involving quality improvement project

**(iv)**Study population: All Newborn admitted to Transition nursery

Methodology

Setting up Team: A quality improvement team will be formed consisting of Neonatology consultants, residents, and nursing staff. Babies requiring any interventions at birth will be excluded from the study.

Baseline phase: The baseline phase will be conducted where-in-admission temperature will be recorded upon admission to the Transition nursery and documented in the Excel sheet. A cause-and-effect analysis of the admission hypothermia will be formed using fishbone diagram based on the observation from our team.

Intervention phase:  Our QI team included consultant neonatologists, all neonatal residents, and nursing staff. One senior neonatologist will play an advisory role and oversee the implementation of the QI. The team will be reviewing the literature on evidence-based practices for thermal care and presenting the recommendations informally, which are then agreed upon or modified for local implementation. The general measures will be taken to implement the thermoregulation bundle, which includes orientation of pediatric and neonatal residents to the bundle recommendations and education of nurses with a power point presentation on various modes of heat loss, its prevention, and adverse effects of hypothermia. A systematic driven PDSA cycle will be conducted with the aim of improving admission temperature in Transition Nursery. With implementation of each PDSA cycle, the results measured in temperature will be analysed using Run chart. Team meeting will be conducted on a regular basis to oversee the quality improvement initiative results and to plan further accordingly.

 Post-intervention phase: Admission temperature will be measured in the post-intervention phase, documented in Excel, and analysed using a run chart.