(—THIS SIDEBAR DOES NOT PRINT—)

DES IG N G U IDE

This PowerPoint 2007 template produces a 36”x48”

presentation poster. You can use it to create your research

poster and save valuable time placing titles, subtitles, text,

and graphics.

We provide a series of online tutorials that will guide you

through the poster design process and answer your poster

production questions. To view our template tutorials, go online

to PosterPresentations.com and click on HELP DESK.

When you are ready to print your poster, go online to

PosterPresentations.com

Need assistance? Call us at 1.510.649.3001

QU ICK START

Zoom in and out As you work on your poster zoom in and out to the level

that is more comfortable to you.

Go to VIEW > ZOOM.

Title, Authors, and Affiliations Start designing your poster by adding the title, the names of the authors,

and the affiliated institutions. You can type or paste text into the

provided boxes. The template will automatically adjust the size of your

text to fit the title box. You can manually override this feature and

change the size of your text.

TIP: The font size of your title should be bigger than your name(s) and

institution name(s).

Adding Logos / Seals Most often, logos are added on each side of the title. You can insert a

logo by dragging and dropping it from your desktop, copy and paste or by

going to INSERT > PICTURES. Logos taken from web sites are likely to be

low quality when printed. Zoom it at 100% to see what the logo will look

like on the final poster and make any necessary adjustments.

TIP: See if your school’s logo is available on our free poster templates

page.

Photographs / Graphics You can add images by dragging and dropping from your desktop, copy

and paste, or by going to INSERT > PICTURES. Resize images

proportionally by holding down the SHIFT key and dragging one of the

corner handles. For a professional-looking poster, do not distort your

images by enlarging them disproportionally.

Image Quality Check Zoom in and look at your images at 100% magnification. If they look good

they will print well.

ORIGINAL DISTORTED Corner handles

Go

od

pri

nti

ng

qu

alit

y

Bad

pri

nti

ng

qu

alit

y

QU ICK START ( con t . )

How to change the template color theme You can easily change the color theme of your poster by going to the

DESIGN menu, click on COLORS, and choose the color theme of your

choice. You can also create your own color theme.

You can also manually change the color of your background by going to

VIEW > SLIDE MASTER. After you finish working on the master be sure to

go to VIEW > NORMAL to continue working on your poster.

How to add Text The template comes with a number of pre-

formatted placeholders for headers and text

blocks. You can add more blocks by copying and

pasting the existing ones or by adding a text box

from the HOME menu.

Text size Adjust the size of your text based on how much content you have to

present. The default template text offers a good starting point. Follow

the conference requirements.

How to add Tables To add a table from scratch go to the INSERT menu and

click on TABLE. A drop-down box will help you select rows

and columns.

You can also copy and a paste a table from Word or another PowerPoint

document. A pasted table may need to be re-formatted by RIGHT-CLICK >

FORMAT SHAPE, TEXT BOX, Margins.

Graphs / Charts You can simply copy and paste charts and graphs from Excel or Word.

Some reformatting may be required depending on how the original

document has been created.

How to change the column configuration RIGHT-CLICK on the poster background and select LAYOUT to see the

column options available for this template. The poster columns can also

be customized on the Master. VIEW > MASTER.

How to remove the info bars If you are working in PowerPoint for Windows and have finished your

poster, save as PDF and the bars will not be included. You can also delete

them by going to VIEW > MASTER. On the Mac adjust the Page-Setup to

match the Page-Setup in PowerPoint before you create a PDF. You can

also delete them from the Slide Master.

Save your work Save your template as a PowerPoint document. For printing, save as

PowerPoint or “Print-quality” PDF.

Print your poster When you are ready to have your poster printed go online to

PosterPresentations.com and click on the “Order Your Poster” button.

Choose the poster type the best suits your needs and submit your order.

If you submit a PowerPoint document you will be receiving a PDF proof

for your approval prior to printing. If your order is placed and paid for

before noon, Pacific, Monday through Friday, your order will ship out that

same day. Next day, Second day, Third day, and Free Ground services are

offered. Go to PosterPresentations.com for more information.

Student discounts are available on our Facebook page.

Go to PosterPresentations.com and click on the FB icon.

© 2013 PosterPresentations.com 2117 Fourth Street , Unit C Berkeley CA 94710

posterpresenter@gmail.com RESEARCH POSTER PRESENTATION DESIGN © 2015

www.PosterPresentations.com

Oral Glucose Gel:

Low Cost, Quick and Effective Management of

Neonatal Hypoglycemia

In a continuous endeavor to maintain best practice for neonatal

care, increasing and maintaining exclusive breastfeeding rates

stays at the forefront of our perinatal department’s agenda. With

the intention to lower the rate of separation of mom’s and babies,

and positively impact breastfeeding we joined forces. In

collaboration with all perinatal areas, lactation, pediatrics,

neonatology, information systems and the families we serve, in

July 2017 we launched the use of oral glucose gel for treatment of

neonatal hypoglycemia. Evidence was presented to all staff

(Harris,etal, 2013)( AAP, 2011 ). Following AAP guidelines an

algorithm was established, policy and practice were updated and

the staff trained one on one. Through two quarters we fine-tuned

our data collection, adjusted to the unexpected new glucometers,

and managed to drop our rate of admission to NICU with a primary

diagnosis of hypoglycemia from 12% to 3% of all hypoglycemic

neonates born at our community NICU.

INTRODUCTION

OBJECTIVES

A Gap analysis early in the project revealed a general lack of knowledge,

absence of dextrose Gel in the institution, and a clear ordering method. As

the project was adopted by the Pediatric committee and the unit based

nurse committees from Couplet Care, the NICU and lactation teams, the

need for a strong multilevel education plan became clear. All stakeholders

including the pharmacy and information technology team would be

involved. A GANNT chart kept us abreast of our progress, and leaders

from every area kept the conversation alive with monthly updates avoiding

a surprise practice change for all staff involved.

Major Goals Met- 15 months

1. Buy in from Neonatology

2. Creating a Policy: Many revisions

3.Add 40% Dextrose Gel to formulary

a) Pricing

b) Stock in medication dispensing machine

c) Documentation in EMR

d) Multi-dose tube scanned with every administration

4. New order: added to hypoglycemia order set

a) Originally not pre-checked

b) Pre-checked as Physician confidence grew

c) Originally physician notification with every dose

5. Staff Training:

a) New algorithm

b) Pharmacy training

c) Medicine: 95% communication by phone with pediatricians

d) Neonatology: awareness of process and availability of product in

nursery

e) IT: Training all users to utilize the order

f) Nursing: Gel administration, 1:1 hands on training, blood sugar

follow up, and team communication and support

METHODS AND MATERIALS CONCLUSIONS & DISCUSSION

The use of oral Dextrose Gel is a viable, cost effective method of treating

neonatal hypoglycemia. Within 3 fiscal quarters, the rate of babies with

hypoglycemia admitted to NICU dropped from 12% to 3%. However, the

target is moving and difficult to stay ahead of. With differing

recommendations for “normal blood Sugars”, and the pressing issue of

exclusive breastfeeding this algorithm remains a hot topic.

• With the First two patients receiving gel, the second blood sugar

remained below 30 mg dL, thirty minutes after the dextrose gel dose.

They were taken to NICU for IV Dextrose, but blood sugar in NICU

was> 60 g/dL, the baby went back to the mother, and we lengthened the

interval between dose and recheck of blood sugar.

• The first ever dose of glucose gel given was on a weekend. It was

requested by a pediatrician. The staff were annoyed that it was so hard

to obtain- because go live was not until Monday. The pharmacist found

it and a dose was given, keeping the baby with the mother. Go Live that

Monday, took care of that.

• Originally, Staff needed to notify the pediatrician for an order prior to

every dose. This generated too many calls and the algorithm was

adjusted

REFERENCES

AAP (2011). Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 3

(127). Retrieved from http://pediatrics.aappublications.org/content/127/3/575.short

Bennett, Fagan, Chaharbakhshi E, Zamifirova, & Flicker (2016). Implementing a protocol

using glucose gel to treat neonatal hypoglycemia, Nursing and Women’s Health. 2016 Feb-

Mar;20(1):64-74.doi: 10.1016/j.nwh.2015.11.001 Epub, 2016 Feb 12.

Cochrane Review, (2016). Oral dextrose gel for treatment of newborn infants with low blood

glucose levels. Retrieved from: http://www.cochrane.org/CD011027/NEONATAL_oral-

dextrose-gel-treatment-newborn-infants-low-blood-glucose-levels

Harris DL, Weston PJ, Signal M, Chase JG, & Harding JE ( 2013). Dextrose gel for neonatal

hypoglycemia randomized, double blind, placebo-controlled trial. Lancet. 2013

Dec.21;38(9910):2077-83. doi: 10.1016/S0140-6736(13)61645-1

Office of the surgeon General (2011). The surgeon general’s call to action to support

breastfeeding. Publications and reports of the surgeon General. Retrieved from:

https://www.surgeongeneral.gov/library/calls/breastfeeding/index.html

WHO (2010). Health Topics: Breastfeeding. Retrieved from:

http://www.who.int/topics/breastfeeding/en/

ACNOWLEDGEMENTS AND CONTACT

Sharon McMahon APRN, CNS- mcmahonsk@henrymayo.com

Mary Beth Sweet, IBCLC- sweetmb@henrymayo.com

Mary Welch, BSN, RNC-NIC welchm@henrymayo.com

Sally McGann, Director, HMNH Perinatal, mcgannst@henrymayo.com

Newborn Pediatric Committee HMNH

It has been amply demonstrated that exclusive breastfeeding positively

impacts the health of both mothers and babies (USDHHS, 2011).

In our community hospital, while approximately 400 bedside neonatal

blood sugars per month are checked secondary to risk factors for

hypoglycemia or demonstrations of symptoms of low blood sugar (AAP,

2013), only about 10 % of those patients are admitted to NICU for

hypoglycemia. These newborns are separated from their family negatively

impacting their ability to establish exclusive breastfeeding during the

newborn inpatient stay. In an effort to keep mothers and babies together

and allow optimal opportunities for skin to skin, preservation of the family

unit, and unlimited access to breastfeeding, oral Dextrose gel for treatment

of neonatal hypoglycemia was implemented.

Henry Mayo Newhall Hospital

Sharon McMahon APRN, CNS NICU Mary Beth Sweet, IBCLC

Addressing Barriers to Exclusive Breastfeeding

Keeping Moms and Babies Together: Dextrose Gel and Neonatal Hypoglycemia

Evidence

HMNH ALGORITHM

RESULTS

Within 3 fiscal quarters, the rate of admission to NICU for hypoglycemia

dropped from 12% to 3%.

The total number of necessary blood sugars for newborn nursery and

NICU combined dropped 20%.

DOSE: 0.2 grams Glucose / kg / dose

(D10W = 0.1 gram / mL) Glutose Gel = 0.4 gram / mL

STAFF EDUCATIONAL POSTER

- -

Dextrose is Glucose is Dextrose

Weight in

kg

Dose of 40%

Oral Gucose Gel

in grams

Volume, mL

2 0.4 1

2.5 0.5 1.25

3 0.6 1.5

3.5 0.7 1.75

4 0.8 2

4.5 0.9 2.25

5 1 2.5

Asymptomatic with Risk FactoRS:

Infant of Diabetic Mother (IDM)

Large for Gestational Age (LGA) or BW ≥ 4000 grams

Small for Gestational Age (SGA) or BW ≤ 2500 grams

Late preterm: 35 0/7 – 36 6/7 weeks gestation

Symptomatic Any Time During Stay:

Jittery, tremors, seizures

Lethargy, poor feeding

Apnea, respiratory distress

Hypotonic, floppy, irritable

Exaggerated Moro

High pitched, feeble cry

BIRTH Immediate Skin-to-Skin and Assist with Breastfeeding

POCT #1 After Breastfeeding, within 1 hour of birth

Immediately upon demonstration of symptoms

RESULTS: Bedside glucose

check = POCT Encourage mom to hand express and feed back any available EBM

in Addition to any other feeding orders

Less than 30 mg /dL

Give a dose of Oral Glucose Gel 0.5 mL/kg per policy

Give supplemental formula feeding 15-30 mL Keep baby Skin-to-Skin, continue assisting with breastfeeding,

hand expression and feeding back any EBM

or 31 – 39 mg / dL

Give a dose of Oral Glucose Gel 0.5 mL/kg per policy Keep baby Skin-to-Skin and continue assisting with breastfeeding,

AND hand express and feedback any EBM

or Greater than 40 mg/dL

Continue feeding every 2-3 hours

and check blood sugar before every feed for 24 hours

Continue feeding every 2-3 hours and

check blood sugar before every feed until 3 consecutive results are greater than 45 mg/dL

POCT #2 1 hour after last POCT-at least 45 minutes after gel dose Less than 30 mg / dL

Give a dose of Oral Glucose Gel 0.5 mL/kg per policy

Give supplemental formula feeding 15-30 mL Keep baby Skin-to-Skin, continue assisting with breastfeeding,

hand expression and feeding back any EBM If this is the second sugar <30, Notify MD and consider transfer to NICU

or 31 – 39 mg / dL

Give dose of Oral Glucose Gel 0.5 mL/kg per policy Keep baby Skin-to-Skin, continue assisting with breastfeeding,

And hand express and feedback EBM

or Greater than 40 mg/dL

Continue feeding every 2-3 hours

and check blood sugar before every feed for 24 hours

Continue feeding every 2-3 hours and

check blood sugar before every feed until 3 consecutive results are greater than 45

mg/dL

POCT #3 1 hour after the last POCT- at least 45 min after gel dose

Less than 30 mg / dL

Immediately Give a dose of Oral Glucose Gel 0.5 mL/kg per policy with supplemental formula feeding 15-30 mL

Keep baby Skin-to-Skin and continue assisting with breastfeeding

If this is the second sugar <30, Notify MD and consider transfer to NICU

or 31 – 39 mg / d

Give a dose of Oral Glucose Gel 0.5 mL/kg per policy

Keep baby Skin-to-Skin, continue assisting with breastfeeding, hand expression and feeding back any EBM

(Up to 6 doses of Glucose Gel may be given within the first 48 hours of life)

or Greater than 40 mg/dL

Continue feeding every 2-3 hours

and check blood sugar before every feed for 24 hours

Continue feeding every 2-3 hours and

check blood sugar before every feed until 3 consecutive results are greater than 45

GEL+

Formula+

BF

GEL+ BF

GEL+ BF

GEL+ BF

GEL+

Formula+

BF

GEL+

Formula+

BF