LAUSR

Background Neonatal hypothermia is a common problem which leads to harm and avoidable admissions in term babies. Hypothermia is defined as an axillary temperature of less than 36.5°C. Our Trust was a member of the Avoiding Term Admissions into Neonatal Units (ATAIN) programme. This multi-professional project aligns with recommendations in Better Births and the West Midlands Patient Safety Collaborative. Aim To reduce neonatal hypothermia in term babies by 50% over 6 months from November 2016 to April 2017 and eliminate it by November 2018. Methods We introduced a neonatal hypothermia bundle with six elements: keep room draught free, dry baby, apply pre-warmed hat, skin to skin contact, measure temperature of the baby and room within the first hour. We used the Model for Improvement and multiple PDSA Cycles. Changes included locking corridor windows, fitting thermometers in each room, using hats on every baby, new towel warmers, the bundle sticker, parent teaching at antenatal classes and staff interprofessional learning, based on a 9-step process (with a video we created). Results Prior to the introduction of hypothermia bundle, between May and October 2016, 24 out of 120 (20%) babies admitted to the Neonatal Unit, were hypothermic. In term babies, hypothermia reduced in the first six months after introducing the bundle, to 9.75% followed by a gradual raise over the last eighteen months to a current value of 14.1%. Most of these hypothermic babies were admitted from labour ward (58%). Although only 78% of hypothermia bundles were filled between April 2018 -June 2018 in a snap shot check of 10 weekly random samples in maternity ward, we found that all babies had their temperature recorded and only 5.8% of maternity ward babies (7 out of 120) were actually cold. Conclusion There was an initial significant reduction in the admission rate of the hypothermic term babies. Staffing changes and other pressures affected the focus on the project. We will reflect on how best to sustain improvement.