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First Golden Hour of Life: A Quality Improvement Initiative

Lambeth, Tinisha M. DNP, RN, NNP-BC; Rojas, Mario A. MD, MPH; Holmes, Amy P. PharmD; Dail, Robin B. PhD, RN, FAAN

Section Editor(s): Ikuta, Linda MacKenna MN, RN, CCNS, PHN; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000306
Clinical Issues in Neonatal Care

Background: Very low birth-weight (<1500 g) infants are vulnerable to their environment during the first hour after birth. We designed an evidence-based golden hour protocol (GHP) with a goal to stabilize and perform admission procedures within 1 hour of birth at a level IIIB neonatal intensive care unit (NICU).

Purpose: The aim of this quality improvement project was to ascertain whether an evidence-based GHP would improve care efficiency and short-term outcomes.

Methods: Rapid cycles of change using Plan Do Study Act were utilized to document progress and gain knowledge during the quality improvement project. Measures were plotted with statistical process control methods (SPC), which analyzed improvement over time.

Results: Both admission temperature and glucose-level means were within reference range throughout the project and predicted a stable process. We observed significantly decreased time to initiation of intravenous fluids and antibiotics. An upward trend of surfactant administration within the first 2 hours of life was also observed.

Implications for Practice: The use of a GHP provided an organized approach to admission procedures and care. By using a checklist and recording intervention times, NICU caregivers were more aware of time management for each intervention and were able to decrease time to initiation of intravenous fluids and antibiotics.

Implications for Research: Future research should focus on establishing normal blood pressure ranges and safe pain management during the “golden hour” and beyond. Future quality improvement should focus on improving subsequent temperature and blood glucose levels after admission umbilical artery and venous catheter placement.

Wake Forest University School of Medicine, Winston–Salem, North Carolina (Drs Lambeth and Rojas); Novant Health Forsyth Medical Center, Winston–Salem, North Carolina (Drs Lambeth, Rojas, and Holmes); and Duke University School of Nursing and School of Medicine, Durham, North Carolina (Dr Dail).

Correspondence: Tinisha M. Lambeth, DNP, RN, NNP-BC, Novant Health Forsyth Medical Center, 3333 Silas Creek Pkwy, Winston–Salem, NC 27103 (

The authors have no financial relationships relevant to this article to disclose.

© 2016 by The National Association of Neonatal Nurses