Golden Hour(s)
Golden Hour(s) Alta Kendall MN ARNP NNP-BC Candidate, Doctor of Nursing Practice Mednax Medical Group of WA In service to the Neonatal Intensive Care Unit at Multicare Tacoma General Hospital May, 2015 Disclosures • I am honored to be with you today • No financial or product affiliations • No off-label usage Objectives • Define neonatal golden hour(s) Objectives • Compare and contrast: transition to extrauterine life for the term and preterm infant Objectives • Discuss: better practices to facilitate teamwork during resuscitation and transition and promote optimal outcomes Ancillary Goal • Staying awake for the LAST presentation of the day…. • You will use this content in your practice every day, and that is a We are not reviewing... • NRP • S.T.A.B.L.E. • Unit-specific practices or protocols Promoting Critical Thinking 9 Golden Hours Conceptual Basis Adult Trauma Neonatal Golden Hours First hours of life set the stage for short and long-term outcomes Golden Hours • Term infant • Late preterm infant Golden Hours • Preterm infant • LBW • VLBW • ELBW Transition Reminder: birth at any gestational age Transition involves the greatest number of critical physiologic changes Transition in the smallest period of time Transition an individual will experience in their entire lifetime. Transition Totally new experiences! ~ lungs begin gas exchange ~ fetal circulatory pathways ~ metabolic processes ~ sensory inputs Born at Term Early cries → lung expansion Relaxation → awakening → activity Breast crawl → exploring → suckling Sleep Born at Term The term neonate experiences: warmth and calm comfort familiar maternal heartbeat bonding Born Preterm Resuscitation → maternal separation Admission → maternal separation Procedures → maternal separation Born Preterm The preterm neonate experiences: loss of warmth loss of comfort loss of familiar heartbeat sound No time for bonding! The Care Team Urgency to do everything NOW ~ Resuscitation ~ The ABCs ~ THERMOREGULATION ~ Glucose/metabolic support ~ Infection prevention Potential Failures ~ Succumbing to the chaos ~ Lack of effective teamwork ~ Miscommunication ~ Preventable Error Performance Impacts Immediate and long-term sequelae Optimal outcomes Resuscitation Notification – coordinate - standardize Who responds? Available assets – who maintains? Resuscitation Ongoing communication Repeating orders Recorder – identify upon entry Stabilization Resist the temptation to grab and run Remember all components of care Update family – even briefly Stabilization Warmth: exception - suspected HIE Reduce stimulation Update family – even briefly Family Support Time of high stress Manage our own responses to stress Recognize stress-mediated responses Family Support Positive affirmation of new life Empathetic acknowledgement Explain everything, but be brief! The Whole Package Plan ahead for Golden Hours communicatecommunicatecommunicate collaboratecollaboratecollaborate The Whole Package Establish checklists, procedures Understand individual roles Team evaluation and debriefing How do we measure? Infant response Feedback from family Care Team functioning What is Needed Coordinated, high quality care DURING the critical hours following birth TO ENSURE Optimal outcomes What is Needed Standardized approach to Golden Hour Practice and procedures based on Best Available Evidence! What is Needed Strive for minimal intervention on each admission BUT Be prepared for maximal response No Substitute For Clear, precise communication Coordinated, collaborative teamwork Accurate assessment skills Strong and efficient clinical approach We did it! As you leave today... 43 Be grateful for the country where we live 44 Cherish the privilege of caring for our future 45 Go Hawks! 47
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