Promoting Newborn Safety Using the RAPPT Assessment and Considering Apgar Criteria: A Quality Improvement Project

PurposeThe aim of this project was to evaluate the implementation of the Respiratory, Activity, Perfusion, Position, and Tone (RAPPT) instrument in assessing the infant’s transition to extrauterine life while in skin-to-skin contact (SSC).Sample/DesignNurses (n = 17) completed a pretest and posttest of RAPPT and Apgar scoring knowledge, attended an in-service about accurate scoring, and were observed during 17 deliveries when newborns were in SSC.Outcome VariablesPrimary variables were knowledge scores, use of RAPPT, and accurate RAPPT scoring. Apgar scoring was also measured.ResultsKnowledge scores increased significantly after education, RAPPT scores were correctly assessed, and 1 of 17 newborns had a sudden unexpected postnatal collapse. Apgar scoring accuracy did not change and nurses reported that their Apgar scores were based on their overall impressions of the infant instead of Apgar criteria.