Standardized Dextrose Gel Policy Implementation for Management of Asymptomatic Neonatal Hypoglycemia

Abstract

Problem: Asymptomatic neonatal hypoglycemia in the first 48 hours of life is a frequent challenge faced by newborns. Timely management is crucial to minimize negative impacts. Data collected from the mother/baby unit of one community hospital demonstrated that despite introduction of oral dextrose gel in 2018, neonatal intensive care unit transfers and exclusive breastfeeding in neonates with asymptomatic hypoglycemia who received gel did not improve. Purpose: The purpose of the quality improvement (QI) project was to implement and evaluate the effectiveness of a standardized policy guiding the administration of oral 40% dextrose gel in at risk neonates ≥ 35 weeks’ gestation who presented with asymptomatic hypoglycemia within the newborn nursery at a community hospital in the United States. Methods: In collaboration with nursing and medical leadership, the project lead created an evidence-based policy, updated neonatal hypoglycemic algorithms to align with the policy, and developed standardized orders for the dosing and administration of oral glucose gel. Essential to project success was the development and implementation of a plan to improve nursing knowledge and compliance through PowerPoint presentations, simulated gel administration demonstrations, as well as dissemination of the updated algorithm on the unit. Data was obtained through weekly audits and tracking outcomes such as NICU transfers and exclusive breastfeeding rates. Results: Due to unforeseen delays, including the COVID-19 pandemic, project implementation occurred in two stages. All unit nurses (n=33) were educated on administration of oral glucose gel and the updated policy and algorithm by November 1, 2020. This measure alone resulted in decreased NICU transfer rates for infants with asymptomatic neonatal hypoglycemia. The second stage, policy/algorithm implementation, went live on December 21, 2020. All of the neonates who met the inclusion criteria (n=27) received intervention(s) consistent with the policy. Though NICU admission rates related to asymptomatic hypoglycemia remained low, exclusive breastfeeding rates did not increase. Conclusions: Future QI cycles should include further data collection to observe outcomes consistent with literature evidence. Potential implications include a focus on maternal breastfeeding preference within the electronic health record (EHR) to determine if exclusive breastfeeding rates in those mothers who wish to do so will improve.