NICU_TeamActive surgical ICU nurse also practices law

As soon as Raye Linn Leukart, NNP-BC, gets word that a mother is about to give birth to an extremely premature baby, it’s “game on.”

Raye Linn, a neonatal nurse practitioner, springs into action and calls a team huddle in the neonatal intensive care unit (NICU).

“Like a coach, she gathers everyone who will be involved in the baby’s delivery,” says Jennifer Thompson, manager of Nationwide Children’s Hospital NICU at The Ohio State University Wexner Medical Center. “They draw up a game plan and communicate with each other about exactly what their roles will be during the baby’s birth and those all-important hours afterward.”

Raye Linn initiated the concept of the team huddle as leader of the Golden Hour Quality Improvement Work Group. The group’s goal is to make sure these tiny newborns get timely, vital care during the “golden” hours after birth.

“Evidence shows the first hours of a small baby’s life are extremely critical and predictive of his or her outcome and quality of life,” Jennifer explains. “During this time, Raye Linn mentors residents, nurses and respiratory therapists and helps guide what needs to be done.”

Raye Linn embraces the medical center’s core value of ownership — working to give each tiny baby the best possible chance at a healthy life.

Premature babies need timely care during the “golden hour”

Each year at the medical center, nearly 50 babies are delivered at less than 28 weeks’ gestation. Their weight is usually less than 2½ pounds. Their organs are not fully formed, and it takes all hands on deck to help them survive.

“They are the smallest, most fragile infants, and they need immediate care and stabilization,” says Michael Stenger, MD, neonatologist and medical director of the NICU.

Raye Linn and her Golden Hour delivery teams take specific steps to reduce each baby’s risk of hypothermia, hyperglycemia and sepsis.

“Our goal is to have the baby’s temperature in a normal range, IV fluids administered, antibiotics given and baby stabilized within about 135 minutes after birth,” she says. “It’s really a ‘golden beginning,’ not literally an hour.”

To help the babies survive, advanced planning is critical. And that’s why the team huddle is so important.

“We go through a checklist,” Raye Linn says. “We discuss who will attend the delivery, who will place the nursing orders, who will place the umbilical line, what type of ventilator the baby will need, how much IV fluids the baby will get — every detail.”

Before a birth, they even increase the delivery room temperature to between 74 and 78 degrees Fahrenheit, which results in better outcomes. And, of course, the nurses warm the isolette and have the necessary equipment ready and waiting.

“The Golden Hour project ensures we are executing the highest-quality, evidence-based practice during the first hours of a small baby’s life,” Jennifer says.

Golden Hour tracking starts at birth

Giving these tiny babies the right care at the right time is so critical that the nurses put themselves on a timer — a hallmark of the Golden Hour initiative.

“The clock starts the minute the baby is born,” Raye Linn says. “The nurses use a quality improvement tracking sheet. They track when the baby is born, when the first temperature is taken, how long it takes to get fluids started, how long it takes to establish a neutral thermal environment…every piece of the timeline.”

By tracking their work, the nurses are empowered to improve patient care. And so is everyone else involved with a Golden Hour baby, whether they’re actually delivering the baby, taking X-rays or preparing medication in the pharmacy.

Gentle care, including a moment for bonding

Although everyone works quickly to care for these infants during the Golden Hour, they work with a calm, light touch because the baby’s nervous system has not fully developed.

“We keep our voices low around these tiny babies,” Jennifer says. “We don’t want to surprise them or stun them.”

To help the babies feel like they’re still in the warm, comfortable surroundings of their mother’s womb, the nurses place them in a nest of soft materials in their isolette.

“Premature babies need containment. So we keep their legs close to their body so they feel tucked in,” explains Raye Linn. “We go to great lengths to keep the baby warm. If babies are hypothermic, it increases their morbidity significantly.”

Since these babies are usually whisked away to the NICU, Raye Linn takes ownership to make sure the anxious parents get a chance to welcome their little one.

“After we stabilize the baby, we try to provide the parents with a special moment — a photo, a touch or a look so they can start bonding — because it may be a few hours before they have the opportunity to see their baby again.”

Golden Hour success is in the numbers…and in the arms of grateful parents

As a leader of the Golden Hour quality improvement project, Raye Linn’s job is to track outcomes. Each month, she leads meetings to discuss every baby born at less than 28 weeks’ gestation.

“She collects data from patient charts, and we review our key interventions,” Dr. Stenger explains.

“We look at what we did to help these babies and how we can improve,” Raye Linn says. “Each team gets feedback.”

“When compared with other NICUs around the country, our survival rates at the Ohio State Wexner Medical Center are much higher than expected for these types of babies, and the Golden Hour has played an important role in that,” Dr. Stenger says.

Meanwhile, Raye Linn has spearheaded a citywide Golden Hour initiative, so this program is helping babies in other hospitals around central Ohio, too.

Every once in a while, parents send thank you cards or stop back to visit the NICU when they celebrate their baby’s first birthday.

“It’s such a pleasure to see these babies surviving and thriving,” Raye Linn says. “And I’m so proud of our delivery teams that gave them such a high level of care.”

Improving – By the Numbers

Because of their hard work, NICU teams at the Ohio State Wexner Medical Center have made great improvements in giving the right care at the right time. Between 2015 and 2018, Golden Hour tracking sheets show:

  • Average time to administer IVs improved by 19.4%, down from 129 minutes to 104 minutes.
  • Average time from birth to give ampicillin, an admission antibiotic, improved by 43.2%, from 162 minutes to 92 minutes.
  • Average time from birth to give gentamicin, another admission antibiotic, improved by 29.1%, from 172 minutes to 122 minutes.
  • Average time to help newborns achieve two stable temperatures improved by 27.6%, from 87 minutes to 63 minutes.

This is one of a series of articles describing how Ohio State employees are leading the way by embodying the Buckeye Spirit in everything they do through shared values of inclusiveness, innovation, determination, empathy, sincerity and ownership.

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