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Q Bulletin, Volume 1, No. 32 (Supplement 1), Jan - Dec 202412th National QA Convention, 8 %u2013 10 October 2024OP-09Towards Reducing the Percentage of Hypothermia among Newborn upon Admissionto Neonatal Intensive Care Unit (NICU)See JK, Nurul Jannah AM, Siti Aisyah MR, Aimi CMDepartment of Paediatrics, Hospital Tengku Ampuan Afzan, JKN PahangSELECTION OF OPPORTUNITIES FOR IMPROVEMENT:A Malaysian meta-analysis revealed 64.5% of neonates were hypothermic (<36.5oC) during admission.This can be prevented by effective thermoregulation during newborn resuscitation. Hypothermia hasmultiple life-threatening complications which increases morbidity and mortality. This study aimed atreducing the percentage of neonatal hypothermia upon admission to NICU in Hospital Tengku AmpuanAfzan (HTAA) by optimising thermoregulation during neonatal resuscitation.KEY MEASURES FOR IMPROVEMENT:Key indicator is the percentage of hypothermia upon admission. Thermoregulatory measures duringresuscitation were assessed based on Model of Good Care. Axillary temperature was measured uponNICU admission. In the first-half of 2023, 60% of neonates admitted to NICU HTAA were hypothermic.The standard percentage of neonatal hypothermia is <20%.PROCESS OF GATHERING INFORMATION:Quality improvement study was conducted in NICU HTAA from January 2023 to February 2024.Universal-sampling was used, where we reviewed the resuscitation of 158 newborns admitted to NICU.Axillary temperature of neonate was measured during resuscitation at different timepoints and uponadmission to NICU and was documented in a resuscitation log. Thermoregulation and corrective steps ofhypothermia were also reviewed via checklist.ANALYSIS AND INTERPRETATION:Incidence of hypothermia were highest among Very Preterm newborn (83%), Very Low Birthweightnewborn (92%), and newborns delivered in the operating theatre (68%). Percentage of hypothermia isinversely proportionate with gestational age and birthweight.STRATEGY FOR CHANGE:We introduced a standard thermoregulation protocol during newborn resuscitation and incorporated it intothe Neonatal Resuscitation Program (NRP) training module for medical staff. A checklist to documentaxillary temperature and corrective thermoregulatory steps for hypothermic babies was also incorporatedin the resuscitation log during standby delivery.EFFECT OF CHANGE:Post remedial action, the overall percentage of hypothermic newborns admitted to NICU improved from60% to 47.5%. Pre-remedial ABNA was 40% and post-remedial ABNA was 27.5%.THE NEXT STEP:Follow-up training will be conducted regularly during department CME. A re-audit will assesscompliance and progress. Detailed thermoregulation steps will be incorporated in the current neonatalresuscitation training module.34 | Page