• Use of Cord Blood for Admission Lab Testing in High Risk Neonates

      George, Ronie; Bode, Claire (2019-05)
      Background: As part of their care in the neonatal intensive care unit (NICU) most neonates require routine admission labs, which could equal up to 10% of their total blood volume. This, and the subsequent lab draws while in the NICU can predispose them to anemia and hypovolemia with the possibility of needing blood transfusions. Local Problem: This QI project is being done in a twenty four bed level three NICU and in a twelve bed labor and delivery (L & D) unit in a major urban medical center in the Mid –Atlantic region. The current practice is to draw admission labs directly from the baby which is not only invasive but also traumatic and expensive considering the supplies used. Participants include registered nurses, neonatal nurse practitioners, neonatologists, laboratory personnel, and information technology staff. Aim: To implement the feasibility of drawing admission labs from the cord blood as an alternative to the current practice of neonatal phlebotomy. The data collected will be the number of staff who are trained to the number of staff working in the L&D and NICU and the number of samples collected from the cord blood to the number of NICU admissions during this timeframe. Interventions: The theoretical framework used here was the Plan Do Study Act. All nurses working in the labor and delivery and NICU and all high risk infants between 22 and 42 weeks who were admitted to the NICU were eligible to participate. An evidence based literature review guided improvement of current practice. Unit based practice guideline, power point presentation, competency checklist and data collection tools were prepared for education, training and data collection. Champions were selected and individual and group training sessions were done. Select cord samples were collected and sent to lab. Results: Education was completed by 80% L & D nurses, and 80% NICU nurses. Samples were collected on 64.47% neonates admitted to the NICU. Based on the posttest administered after the education, 98% agreed that using cord blood for admission labs is safe and reliable and helps prevent pain and other complications. Conclusion: The procedure has a high degree of usability and staff are continuing to collect samples from cord blood. In this present era where our focus is on quality improvement initiatives, making a wise use of available resources like umbilical cord blood will bring about a better outcome for the sick neonate and cost containment for the patients and their family as well as for the organization where it is implemented. In conclusion, cord sampling as an alternative to neonatal phlebotomy is an easily accessible procedure with the potential to improve the outcome of the sick neonates.