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I N N O VAT I V E P R O G R A M S
Proceedings of the 2012 AWHONN Convention
A Pilot Project to Improve Neonatal Peripheral Intravenous Site Assessment and Documentation
Purpose for the Program here is currently no consistent protocol described in the literature for documentation of the nursing assessment of neonatal peripheral intravenous sites. Most authors concur that hourly assessments are the minimum frequency and indicate what the assessment parameters should be; however, they do not discuss a protocol for documentation of the assessments. Multiple authors and professional nursing groups have identiﬁed that problems exist in the care of peripheral intravenous sites in neonates. This project attempted to determine if nurses in a neonatal intensive care unit (NICU) could conduct and document an hourly evidence-based focused assessment of neonatal peripheral intravenous sites.
Lisa Klein, MSN, RNC-OB, RNC-LRN, CNS, Marymount University, Reston, VA Keywords neonatal nursing peripheral intravenous assessment documentation
in neonates. This project introduced a documentation form that includes the ﬁve evidence-based parameters to indicate the status of the peripheral intravenous sites. It attempted to determine if an instrument on which to document the assessment was relevant to the practice of the NICU nurses providing care. The project also determined the time needed to perform and document the peripheral intravenous site assessment and if that time was considered reasonable by the NICU nurses providing care. Implementation, Outcomes, and Evaluation The documentation form was piloted in a large suburban NICU. The short-term goal of this pilot project was to determine if the instrument on which to document the assessment and the time to perform and document it was deemed reasonable by the nurses providing care. The nurses are still participating in the pilot project. Early data suggest that the tool may be helpful but nurses are unsure if all of the parameters are necessary for an adequate assessment. Implications for Nursing Practice It is hoped that this project will stimulate further study of the individual assessment parameters to determine if any or all of them in a tool format are valid and reliable in predicting inﬁltrations and extravasations, which would be useful in improving patient outcomes.
An additional purpose of the project was to obtain input from direct care nurses before initiating a change in practice. Critical care nurses perform multiple hourly assessments and care interventions on each patient. Additional documentation of ﬁve measurement parameters may not be realistic to add to the workload of the direct care nurse. By having the nurses who participated in data collection provide feedback regarding the complexity or simplicity of the instrument, they were able to evaluate the potential value of the process and the instrument to their care. Proposed Change Many NICUs use a system of charting by exception for assessment of peripheral intravenous sites
The Great Pretenders: Utilizing Evidence-Based Practice to Optimize Clinical Outcomes for the Late Preterm Infant
Jaimi S. Hall, MSN, RNC-OB, Peninsula Regional Medical Center, Salisbury, MD Angela T. Houck, DNPc, RNC-nic, RN-BC, Peninsula Regional Medical Center, Salisbury, MD Keywords late preterm infant evidence-based practice
Newborn Care Paper Presentation
Purpose for the Program he late preterm infant faces many challenges associated with prematurity. In 2010, 99 late preterm infants (approximately 5% of the total birth volume) were born at Peninsula Regional Medical Center. Nearly 29% of these infants were admitted to the neonatal intensive care unit (NICU), and 12.8% were readmitted to the pediatric unit for complications associated with prematurity. The purpose of this program was to determine if adopting an evidence-based model of care utilizing the Association of Women’s Health, Obstetric and Neonatal Nurses’ Assessment and Care of the Late Preterm Infant Guideline will improve clinical
outcomes and reduce late preterm infant neonatal intensive care unit admissions and readmissions to the pediatric unit. Proposed Change To adopt, institute, and practice Association of Women’s Health, Obstetric and Neonatal Nurses’ (AWHONN) clinical guidelines for every infant born between 34.0 and 36.6 weeks of gestation at Peninsula Regional Medical Center. Implementation, Outcomes, and Evaluation Data collection took place over a 6-month period to determine baseline rates of hypothermia,
JOGNN 2012; Vol. 41, Supplement 1
I N N O VAT I V E P R O G R A M S
Proceedings of the 2012 AWHONN Convention
hypoglycemia, respiratory distress, feeding difﬁculties, phototherapy, excessive weight loss, neonatal intensive care unit admissions, and readmissions to the pediatric unit. A multidisciplinary team developed the late preterm infant initiative utilizing AWHONN’s clinical guidelines. Components of the initiative included policy and order set development, predelivery and predischarge education, and individualized feeding plans. Beginning March 22, 2011, all late preterm infants were admitted to the intermediate care nursery and cared for with a nurse-to-patient ratio of 1:3 to 4. All aspects of the clinical guidelines were utilized based on the individual needs of the infant. Data collection on these infants began May 1, 2011. To date, 31 late preterm infants have been cared for under the new initiative. Eight of these infants were subsequently admitted to the neonatal intensive care unit (25.8%), and no infants were readmitted to the pediatric unit. The overall goal is to improve clinical outcomes while reducing admissions to the neonatal intensive care unit by 10%
and readmissions to the pediatric unit by 5%, as compared with the 2010 rates. Implications for Nursing Practice As the primary bedside caregiver, nurses are extremely vested in their patients’ outcomes. This initiative has led to an increased staff awareness of this population, their unique needs, and the challenges they face. This knowledge, coupled with the utilization of evidence-based care, translates into improved clinical outcomes for the late preterm infant. This initiative also has improved teamwork and communication and has fostered relationships between nurses and other health professionals. Family-centered care is at the core of obstetric nursing as well as this initiative. Providing care that enhances family bonding, empowers parents, and improves clinical outcomes increases patient and nurse satisfaction. In this era of rising health care costs and nonreimbursement for preventable readmissions, it behooves nurses to adopt practices that anticipate and prevent possible sequelae related to late prematurity.
Tackling Newborn Hypoglycemia in the Delivery Room: Utilizing Colostrum, Skin to Skin and State of the Art Policies
Purpose for the Program ewborn hypoglycemia in the delivery room is a widespread challenge. Most often infants who are breastfed and are temporarily separated from their mothers receive formula as a quick ﬁx to increase blood glucose levels. This approach not only decreases breastfeeding success, but it also exposes the newborn to unstable levels of glucose because of the formula’s stimulation of insulin production. Too many infants who are breastfed receive excessive amounts of formula within the ﬁrst hour of life because their glucose values are checked before feeding, as soon as 15 to 30 minutes after birth. After witnessing a 40-minute-old newborn receive 40 ml of formula for a glucose level of 40, then promptly vomit, gag, and turn dusky, I decided it was time to act on my concerns that something was out of balance regarding the blood sugar/feeding issue.
edge, coupled with my nursing experience, prepared me well for presenting my ideas to the administration. I also proposed that we establish ways to give colostrum to babies who were not ready to latch effectively. I wanted to rewrite the existing breastfeeding policy, have nurses adhere more vigilantly to our skin-to-skin policy, write a policy on prebirth hand expression of colostrum, and be a driving force to change many of the parameters of the newborn hypoglycemia algorithm.
Pamela Kinney Tozier, BSN, RNC, CCE, IBCLC, Maine Medical Center, Portland, ME Keywords hypoglycemia diabetics hand expression colostrums skin-to-skin
Newborn Care Paper Presentation
Proposed Change To attain stable glucose levels in babies who are breastfed by giving infants drops of colostrum, feeding them before labs are checked, and keeping them in continuous skin-to-skin contact. I had recently become an international board certiﬁed lactation consultant, and that new level of knowl-
Implementation, Outcomes, and Evaluation We have successfully implemented a new hypoglycemia algorithm that accepts lower glucose values initially, has the newborn feed ﬁrst, and then the ﬁrst glucose level checked by 90 minutes of age. We have implemented widespread hand expression of colostrum, before and after childbirth, for all of our diabetic patients who are breastfeeding, and we have maintained continuous skin-to-skin contact as a norm. The outcomes to date have been a decrease in separation of the mother and baby, higher newborn glucose levels, higher patient satisfaction, and better success of breastfeeding.
JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
T. and Evaluation It was noted during the ﬁrst year. 83 sets of twins. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Implications for Nursing Practice Labor and delivery nurses are the ﬁrst line of defense in helping stabilize newborn glucose lev- els without the introduction of formula. During the 3 years. University of California San Diego Medical Center. ranging from Implementing Practice Protocols and Education to Improve the Care of Infants with Neonatal Abstinence Syndrome Katherine Y. RN. looking for ways to improve milk transfer. Both providers and nurses are involved in every aspect leading to increased patient and staff satisfaction. It was noted that following hospital discharge. and 12 sets of triplets. Visits are individualized. Outcomes have improved. a plan is developed to help the mother reach the desired goal. In 2006. Premature Infant Nutrition Clinic Terry Lawson. the team sees 7 to 8 patients in a 4-hour session. including a Premature Infant Nutrition Clinic Quality Assurance project. San Diego. increase milk supply. After the assessment and discussion. and the third year. 97 patients/183 visits occurred. 83 new patients. CA Keywords human milk premature infant nutrition lactation consultant Newborn Care Paper Presentation Purpose for the Program he beneﬁts of human breast milk for term infants outweigh formula. and increased exclusive breastfeeding. Utilizing a team approach. 104 newborns 34 to 33 6/7 weeks of gestation. 90 newborns 30 to 33 6/7 weeks of gestation. Cape Fear Valley Health System. the University of California San Diego Medical Center was designated as Baby Friendly. Implementation. and 40 newborns greater than 37 weeks of gestation. It is possible for just one nurse with a vision to apply evidencebased practice to achieve quality outcomes. the gestational age breakdown included the following: 46 newborns less than 30 weeks of gestation. Care and management of these infants can be improved with practice guidelines and education. Vol.Lawson. These infants continued to require fortiﬁers. but supply was decreasing.to 60-minute session. Implications for Nursing Practice Assuring best practice and performing research is exempliﬁed by the projects in progress. Breast milk is an even greater beneﬁt to the preterm infant because it provides infection prevention and promotes improved neurodevelopment. At the end of the 45. Research that is more recent describes an increasing incidence of infants T exposed to harmful substances prior to birth. Lucas. but we did not know how much or for how long. Multiples data included 215 singletons. more breastfeeding. The American Academy of Pediatrics reported that 50% to 95% of infants exposed to opioids or opioid derivatives. decreased/no breast pumping. the registered nurse performs a lactation consult and assesses the infant feeding. thereby upholding the standard of best practice. the Premature Infant Nutrition Clinic was established by a pediatrician and registered nurse. JOGNN 2012. most mothers were not successfully breastfeeding their premature infants. Proposed Change In August 2008. Optimal treatment of this NAS population is hampered by the current lack of evidence-based standardized guidelines and protocols for pharmacologic management and care that promote improved outcomes for NAS patients. the second year. Fayetteville. APRN. 1 day a week. Babies exposed to opioids or opioid derivatives during pregnancy are at increased risk of developing NAS. 41. There is a need to expand to 2 days to manage the increase in consultations. visits included infant’s growth and development assessments and discussions of the mother’s concerns. 130 new patients/637 visits occurred. The Supporting Premature Infant Nutrition program was launched in 2007. such as increased breast milk for longer duration of time. Both parents were exhausted and overwhelmed. develop neonatal abstinence syndrome (NAS). and an international multicenter validation of a preterm growth chart. research of liquid fortiﬁcation of the mother’s milk at discharge. DNP. A follow-up letter is sent to the primary provider with appointment highlights and recommendations. Mothers continued to need to pump. including heroin and methadone. NNP-BC. Outcomes. The goal was to improve the growth and nutrition of preterm infants. IBCLC. Currently. NC Purpose of the Program he National Council on Alcoholism and Drug Dependency estimates that between 1% and 11% of babies born each year are exposed to illicit substances in utero. and increase breastfeeding and decrease breast pumping. Supplement 1 S33 . T one-time only to several visits 1 to 3 weeks apart.
I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Proposed Change To develop and implement evidence-based clinical practice guidelines and an educational program on NAS and the Finnegan Neonatal Abstinence Scoring Tool (FNAST). S1-S118. Tampa. and Evaluation Implementation is in process and awaiting ﬁnal approval of pertinent policies and procedures to T support this program.1111/j. infants.Hospital. and improved patient treatment goals. Outcomes. with 2% to 44% improvement. 41. Education also can equip nurses with the necessary knowledge to care for patients with complex medical problems like NAS. IBCLC. improved professional practice. Implementation. pretest/ posttest study that evaluated change in nursing knowledge about NAS and use of the FNAST after the implementation of a quality improvement. Outcomes.awhonn. educational project. providing nurses with speciﬁc information about a medical problem is correlated with improved adherence to best practice. Frances Fusco.x http://jognn. Minneapolis. Implementation. All 10 nurses who participated in the interactive video test scored 90% or higher against the FNAST criterion 1 week after participation in the educational project. RN. Tampa. are evaluated more closely to ensure their safety. Proposed Change To create and implement a neonatal head trauma CNS-BC. Further. perinatal palliative care infant advanced directives Newborn Care Poster Presentation Neonatal Head Trauma: Implementation of a Care Algorithm to Improve Safety Purpose for the Program o create a process by which newborns with head trauma or at risk of complications of neonatal head trauma are identiﬁed. MHS. Proposed Change To enhance the existing bereavement program to include infants with low viability or no viability through palliative care. BSN. S34 JOGNN. MS. assessed.2012.org . Abbott Northwestern algorithm that is part of the newborn standing or. and families through the Perinatal Palliative Care program. Volunteer participation in the NAS educational project occurred in 81% of the neonatal intensive care unit nurses. Keywords NICU FNAST education Newborn Care Paper Presentation Perinatal Palliative Care: Support of Mothers. Recent research shows that providing education to nurses can result in knowledge gained. RN. J. DOI: 10. Nurses were tested before and after participation in education about NAS. FL Implications for Nursing Practice Provide care and support to both infants and mothKeywords ers going through this experience. RN. and monitored differently with the goal of improving safety. FL Theresa Bish.1552-6909. and improve scoring accuracy with use of the FNAST. T Sandra Hoffman. 2012. MN ders across a large multihospital health system to ensure that newborns who are at risk of head trauma or who have head trauma. The evaluation will be based upon a patient satisfaction survey taken by telephone follow-up of patients discharged from the hospital. University Community Hospital. University Community Hospital. Infants and Families Purpose for the Program o support mothers. and Evaluation This study was a nonexperimental. A subset of 10 nurses was evaluated using the FNAST with video of infants having NAS. All nurses showed some improvement in scores on the posttest. Implications for Nursing Practice Evidenced-based clinical practice guidelines and education on NAS and the FNAST equip caregivers with the necessary tools to consistently and accurately assess an infant with NAS when using the FNAST. to improve nursing assessment and care of the NAS infant.01360.
a multidisciplinary team of neonatal and birthing clinical nurse specialists. promotes appropriate pain management. E. Outcomes. such as subgaleal hemorrhages may manifest at birth or may occur over many hours. Outcomes. shortened infant time at point of delivery for both vaginal birth and cesarean birth. DE infants were signiﬁcantly lower than average in our neonatal intensive care unit (NICU) than the Keywords benchmark of 850 NICUs within the Vermont Oxpreterm ford Network. Proposed Change Root cause analysis using ﬁsh bone techniques was conducted on the ﬁrst ﬁve cases of admission of hypothermia for each calendar month over the 12-month period prior to project inception. 41. and Evaluation Data were analyzed. so identiﬁcation of infants at risk and increased vigilance is important for patient safety. independent of any disease conditions. Body temperature should never be taken for granted. Implementation. and it is essential that infants at risk of complications of a difﬁcult or instrumented delivery are identiﬁed and monitored more closely. It is important to bring key stakeholders in a project to realize gains. Complications. Pamela Braithwaite. view of facility data over the past 5 years showed that the initial admission temperatures of these RN. Newark. pediatricians. a neonatologist. tal intensive care unit among inborn preterm inMiddletown. Christiana Care Health System. After a review of the literature. In addition. increased room temperature. Bear. Supplement 1 S35 . Two large polyethylene studies of infants from 23 weeks to 30 completed weeks of gestation.Braithwaite. Bayne. RNC. The evaluation of this change is ongoing. Clinicians are obligated to benchmark practices that may contribute silently to patient illness. RNC. Staff and physician education was done regarding neonatal head trauma. Donahue.. NNP-BC. BSN. Vol. warming of surfactant. infants who were less than 31 weeks gestational age were prospectively followed and the incidence of the outcome variables was collected. The bundle included a timeout-style thermal checklist. Christiana Care Health System. Implications for Nursing Practice Nurses caring for newborns are in a key position to identify complications of neonatal head trauma that may result from the birthing process. proper radiant warmer preheat and use. Aggressive clinical staff education in labor and delivery and NICU was conducted using a variety of methods. Across this time period. DE C mal intervention bundle was developed and implemented. and helps to keep newborns safe. and warming of caregiver hands. Help! I’m Cold! Improving the Warmth of Our Newborns Purpose for the Program ozy Cuties is a multidisciplinary performance improvement team convened to address hypothermia from birth to admission to the neonaNicole Donahue. Education about neonatal head trauma increases awareness of the risks. N. MSN. suggested that when infants are admitted to the NICU with hypothermia. P. change in transfer technique of newborn to a warmer from point of delivery. Christiana Care. A ther- JOGNN 2012. and the neonatal head trauma algorithm was implemented across a large multihospital health system. BSN. and ﬁndings showed that our admission hypothermia rates have been reduced from 61% over the past 5 years to approximately 18% over the past 6 months. A facility tour determined how many potential causes existed and coupled the potential cause with evidence-based interventions. late onset sepsis is increased by 11% and odds of death are increased by 28%. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Keywords neonatal head trauma vacuum extraction forceps delivery subgaleal hemorrhage Newborn Care Poster Presentation Implementation. their Newborn Care chances of survival decrease by approximately Poster Presentation 10% for every degree below 36◦ C. ReLynn E. Ongoing monitoring for sustained improvement is now in place. 61% of the hypothermia ﬁshbone diagram infants who were less than 31 weeks gestational root-cause analysis age had body temperatures less than 36◦ C at admorbidity mission and were classiﬁed as hypothermic using mortality the World Health Organization deﬁnition. and Evaluation Neonatal head trauma can result in catastrophic outcomes. and a neonatal nurse practitioner created a neonatal head trauma algorithm to become part of the newborn standing orders. Literature was reviewed to establish potential causes. attention to application of pulse oximetry. A standardized approach can ensure the identiﬁcation and closer monitoring of infants who may have an injury that may not manifest for many hours after delivery. PhD. and Bayne. Post-implementation. L. Implications for Nursing Practice A multidisciplinary team can be an extremely effective agent of change. including video and social media. not to rewarm a cold infant. The goal should always be to keep a warm infant warm. effective use of polyethylene wrap. DE fants at less than 31 weeks gestational age.
Most lactation programs have lost state funding in recent years and are now funded by hard-to-ﬁnd grants. T Proposed Change For 10 years. the coordinator of the lactation program and her team perform checks that include weight. We want to increase breastfeeding initiation and duration rates and thereby improve long-term health for every infant.awhonn. Surgeon General’s Call to Action to Support Breastfeeding. Outcomes. Keywords discharge Implications for Nursing Practice satisfaction The best practice was identiﬁed and we continue best practice to maintain the gains by evaluating satisfaction education family centered care levels and random chart audits. Our breastfeeding initiation rate is 87. Maine Medical Center. ME Proposed Change To standardize teaching. At that time we started the clinic model and were encouraged by the positive results. Angela Carswell. Outcomes. We are ahead of the Healthy People 2020 goals of an 81. Our lactation consultants can see ﬁve more infants per day or 25 more per week.01360. We believe our program model is the best practice and is leading the way in breastfeeding promotion and support of the American Academy of Pediatrics Policy Statement and the U. the daily care of their infants. Our 6-month breastfeeding rate is 79. IBCLC. I Implementation.2 full time equivalents. Geraldine Tamborelli.1 full time equivalents. by community beneﬁt dollars. MS. Portland.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Welcome Aboard and Homeward Bound: The NICU Family’s Journey for a Safe Voyage to Discharge Purpose for the Program mprove parent and staff satisfaction with the discharge process and complex follow-up care for the very premature or sick infant. Our home visit model took 3. Mary Greeley Medical Center. multidisciplinary Newborn Care Poster Presentation Birthways Lactation Services: A Model for Breastfeeding Support Purpose for the Program he purpose of the Birthways Lactation Services program is twofold. IA Keywords lactation program exceeding national and state breastfeeding rates Newborn Care Poster Presentation S36 JOGNN. or as in our hospital’s case. Ames. as well as chart audits were used for measurement and feedback.000 in salaries and mileage reimbursement. RN. We also want to increase the lactation consultant’s productivity while decreasing full time equivalents and cost. which represents a savings of more than $140.6% as compared with the state’s 73.1552-6909. and Evaluation Three to ﬁve times per day. and provide a discharge feeding plan for babies with feeding problems. and their personal preferences early on. and our clinic model takes 1. schedule the clinic visits at discharge. S1-S118. and lactation evaluation. 41. Involve parents in the plan of care.S.9% initiation of breastfeeding and a 6-month breastfeeding duration of 60. RN. Implications for Nursing Practice The advantages of breastfeeding are well researched and well documented. documentation. DOI: 10.x http://jognn. our program was set up to provide home visits to our clients (within a 50 mile radius) who either chose to have a visit or when a visit was physician ordered.org .2012. jaundice. 2012. staff and patient satisfaction.9%.3% (one of the best in the state) as compared with the national rate of 17%. and Evaluation Implementation using Plan-Do-Study-Act cycles. Our lactation consultants cross-train to the discharge planning position of the Birthways Lactation Services program where they round with the pediatricians.1111/j. which makes it possible to provide second visits for those clients who need them. Implementation. We believe our outcomes reﬂect the success of the program. Eight years ago. Our service model decreases hospital readmission rates and promotes exclusive breastfeeding with increased productivity and decreased cost. timing of education. and communication of education to better prepare parents for discharge.6%. it was determined this was a costly way to deliver care even with funds provided by a grant and some insurance reimbursement.
representatives from each provider group involved in newborn care collaborated on the creation of the infant feeding plan JOGNN 2012. OhioHealth. OH called Kangaroo care) with the mother has been shown to maintain skin temperature regulation Keywords of the newborn. the plan was located at the infant’s crib. patients report feeling that their infant feeding choices are respected and that the use of this plan prompts infant feeding discussions. During 2010. Outcomes have been measured by patient satisfaction and stable infant temperatures during the time frame. to discuss maternal newborn feeding preferences. BSN. and signed the revised feeding plan. and Evaluation The implementation was started by staff nurses who considered the evidence-based practice of Kangaroo care to be best for the newborn. Proposed Change Before the initiation of skin-to-skin in the postanesthesia care unit. infants had been removed from the warmer after being wrapped with warm blankets and a hat and given to the mother to hold or breastfeed. then we should adopt the practice with the cesarean birth infant. Implementation. infant feeding plan documentation tool was created to identify a mother’s preference for feeding her newborn from birth through discharge. PA Keywords breastfeeding infant feeding plan patient–family centered care Newborn Care Poster Presentation Purpose for the Program lack of communication was identiﬁed surrounding a mother’s feeding decision and multiple health care providers. The staff stated that if the vaginal birth infant could beneﬁt from skin-to-skin. Once feeding preferences were identiﬁed. Columbus. Columbus. The practice of Kangaroo care has been well adopted in our setting. The act of placing the infant skin-to-skin (also Grant Medical Center OhioHealth. Anne Keller. BSN. both the nurse and mother discussed. RNC. increase initiation of successful Kangaroo Care breastfeeding. MS. A document. If any changes to the feeding plan were needed. and the Joint Commission recognized it as a best practice model of care. Outcomes and evaluation are ongoing Prior to the implementation of the feeding plan. The staff started Poster Presentation to initiate Kangaroo care in the postanesthesia care unit to provide all the beneﬁts to the mothers who had cesarean births. Outcomes. Hospital of the University of Pennsylvania. Anecdotally. Implications for Nursing Practice Empowering nurses to change practice to overcome traditional barriers of medical care to promote the empowerment of motherhood. This process was not satisfying to the staff. a mutually agreed upon feeding plan was created and signed by both the mother and the nurse. IBCLC. and Brenneman. Infant Feeding Plan: An Innovative Documentation Tool to Improve Communication between Caregivers and Families Jennifer Peterman. Providers commented that the plan is convenient and useful in practice. Alicia Brenneman. Both are transported to the postanesthesia care unit. and ease the transition for intrautercesarean birth ine to extrauterine life. A. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Operation Kangaroo Care Purpose for the Program angaroo care is recommended in the Guidelines for Perinatal Care for stable newborns. and Evaluation Prior to implementation. CNP. The mother-infant pair is left skinto-skin for the next 60 to 90 minutes. OH K The process before leaving the operating room is to now initiate skin-to-skin with the infant (who is dressed only with a diaper and hat) and apply warm blankets against the back of the infant while leaving its chest exposed. Philadelphia. Throughout the infant’s stay. Implementation. RNC. initial checks are preformed. with the use of a scripted narrative.Keller. This lack of communication resulted in a mother’s perceived lack of respect by providers regarding her preference for newborn feeding. RN. breastfeeding rates were 68% and during the year postimplementation. Providers also noted a large variation between provider practices related to newborn feeding and maternal preference. an innovative. Proposed Change To improve communication between providers and mothers. breastfeeding rates have continued to increase to 74%. The development of the individualized plan began at maternal admission. Supplement 1 S37 . 75% of all mothers who gave birth vaginally Newborn Care participated in skin-to-skin care. To address this issue. updated. A. 41. a crib side infant feeding plan documentation tool was implemented. and a baseline set of vitals is obtained on the infant. Vol. crib side. Patients report they would initiate Kangaroo care with their next birth. Outcomes. Staff began by placing the infant skin-to-skin after moving the mother from the operating room table to a hospital bed.
To estimate the total number of late preterm infants who were consulted and weighed on more than one visit. Late preterm infants often appear to be able to breastfeed successfully during hospitalization. and behavioral services. As 1 of 15 sites for the Association of Women’s Health. Bright.1111/j. (hence. nurses were able to review with the family the evidence associated with optimal infant feeding. pediatric surgery.awhonn. the following formula was used: Numerator – number of late preterm infants who gain weight of more than 0. track weight gain. Ohio. Denominator – total number of late preterm infants consulted/weighed. commitment occurred in this hospital’s outpatient setting to measure and improve post-discharge care of late preterm infants who breastfed. Outcomes. and generate monthly progress reports.1552-6909.456 births/year in 2010). Monitor at-risk groups for anticipated problems and provide a portal for continuing care. Columbus. This tool gave nurses an opportunity to dialogue with the infants’ mothers regarding feeding options and changes in infant feeding as needed. S1-S118. the incidence of late preterm infants who breastfed was 9. Implications for Nursing Practice Accessible community service. especially breastfeeding. OH Whitney Lenger Mirvis. RN-BC. OH Keywords late preterm breastfeeding weigh Newborn Care Poster Presentation S38 JOGNN. DOI: 10. RNC.org . RN. BSN. RN. Obstetric and Neonatal Nurses’ 2010 Late Preterm Infant EvidenceBased Practice Guidelines research study. monitored by ap- proachable staff and expert professionals. monitored by approachable staff and expert professionals is an effective means to continue and grow client relationships. their nickname “the great imposter”).x http://jognn. At admission. Riverside Methodist Hospital. MS. Also. 41. pediatrics. 151 individual late preterm infant weights were measured: 116 had repeated weights and 99% demonstrated weight gain (monthly averages). IBCLC.2012. Columbus. An accessible weigh station was evaluated to be an effective pathway to ongoing care and support for late preterm infants. but this may not be sustained following discharge.7% (of 6. Late preterm infants gained weight appropriately and their mothers reported sustained breastfeeding. In Columbus. Patient–family centered care is based on respect and honest communication between providers and families. free service. the tool served as a contract between the mother and the providers to ensure that the mother’s feeding preference plan was implemented. 2012. Additional beneﬁts included referrals to lactation. Doctors Hospital-Ohiohealth.1% of live births (in 2008) and the rate at our hospital was 7. and Evaluation Utilize a baby weigh station within a user-friendly lactation support center to offer a community accessible onsite. OH Jane Lamp. CNS. IBCLC. A Baby Weigh Station: Continuum of Care for Late Preterm Breastfeeding Infants Purpose for the Program ate preterm infants who breastfeed are the largest segment of preterm infants. Implementation. Over 12 months. The tool also served as an easy way to communicate to any provider caring for the infant. IBCLC. BSN. Columbus. L Proposed Change To ensure a successful continuum of care for the postdischarge late preterm infant via a community resource where 90% of late preterm infants will gain weight after events of lactation consultation and ﬁrst weight measurement. Kathleen H. Columbus.5 ounces at more than 5 days of age and thereafter. Identify late preterm infants who return for repeat weight measurement. Riverside Methodist Hospital. OH Joyce Sheppard.01360.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Implications for Nursing Practice This initiative provided an opportunity for nursing to re-energize their commitments to patient communication and infant feeding. Women’s Health Services. Riverside Methodist Hospital.
Ryan. DC Carol A. RN. we have a unit research council. family. O. MSN. cussion of obstacles to exclusive breast milk feeding Feeding care plans (for complicated situations) developed collaboratively with nurses and international board certiﬁed lactation consultants Implementation of mother and newborn “quiet time” To implement this program. E.Dohnalek. all nurses attended mandatory education session Implementation of 24-hour rooming in (no separation of mothers and newborns via standard nursery) Survey given to patients to identify the most popular reasons for supplementation Journal clubs discussing breastfeeding issues Consultations with lactation consultants at other facilities Increasing rates and duration of initial skin-toskin contact and ﬁrst breastfeeding session Daily patient rounds and assessments by international board certiﬁed lactation consultant Mandatory interdisciplinary breastfeeding education for all nurses. American Academy of Pediatrics. Centers for Disease Control and Prevention. IBCLC. Washington. and Evaluation Hospital. Starrels.. RN. The outcome was that our exclusive breast milk feeding rates increased. C. DC Cynthia Heer. Washington. Department of Health and Human Services. BSN. obstetricians. American College of Ob- E stetricians and Gynecologists. RN. thus changing practice and creating conﬁdence. DC Keywords exclusive breastfeeding exclusive breast milk feeding breastfeeding rates Joint Commission perinatal core measure Proposed Change Over an 18-month period interventions were implemented to increase exclusive breast milk feeding rates by at least 10%. Many of the interventions included in our program are directly aimed at increasing breastfeeding knowledge of our staff and patients. Outcomes. The topic of change regarding exclusive breastfeeding. Georgetown University Hospital. RNCOB. DC Margaret Howland. A. We also are utilizing a patientbased survey to evaluate the effectiveness of the interventions.. IBCLC. A data collection tool was created to monitor and track exclusive breast milk feeding rates. Exclusive Breastfeeding: “It Takes Our Village” Julie Delcasino. BSN. NC Keywords exclusive breastfeeding Newborn Care Poster Presentation Purpose for the Program xclusive breastfeeding is best for the infant and mother. BSN. RN. Georgetown University Implementation. and the Joint Commission for exclusive breastfeeding. It takes our village to educate the mother. and staff within women’s services. Charlotte. Vol. RN. It is the responsibility of us all to help mothers be successful and promote the recommendations of the Association of Women’s Health. our exclusive breastfeeding rate was 37%. Georgetown University Hospital. BSN. FILCA. RN-BC. Heer.. This may improve exclusive breast milk feeding rates because of the effect that this has on patients. RNC-OB. Washington. Evidence-based practice describes this choice. Washington. In May 2010. Wurster. MBA. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Increasing Exclusive Breast Milk Feeding Rates at an Urban Academic Hospital Laurie Dohnalek. r r Elizabeth Starrels. MSN. RN. Implications for Nursing Practice Education is a major aspect of our initiative to increase exclusive breast milk feeding rates. Georgetown University Hospital. Supplement 1 S39 . Presbyterian Healthcare. Within our shared governance structure. hospital supplementation. L. NC Diane Slough. Purpose for the Program NE-BC. Washington. DC Lauren O. DC. RNC-MNN. and education for JOGNN 2012. Howland. Obstetric and Neonatal Nurses. and pediatricians Education related to alternative breast milk feeding methods Outside speaker (international board certiﬁed lactation consultant) that moderated dis- These interventions were implemented and the result was an increase in the staff’s knowledge and skills. M. Washington. Charlotte. Georgetown University o increase exclusive breast milk feeding rates Hospital. but who can say their hospital truly promotes exclusive breastfeeding? We are a 600-bed hospital with more than 7. We realized our shortfall and discussed ways to improve our rate. IBCLC..S. Ryan.000 births/year. the following interventions were completed: r r r r r r r r r r Newborn Care Poster Presentation Creation and implementation of Donor Pasteurized Milk Policy. World Health Organization. Educational programs that increase nurses’ knowledge and improve attitudes toward breastfeeding promote accurate and reliable delivery of breastfeeding information and skills to the mothers. and Wurster. MSN. Presbyterian Hospital. Georgetown University Hospital. C. U. DC T at an urban academic hospital. 41. L. The low incidence of exclusive breastfeeding is partially due to a lack of breastfeeding knowledge among health care professionals. Proposed Change We want to provide best patient care. These programs also encourage positive role modeling of supportive breastfeeding attitudes.
” What about labor and delivery nurses who say. The nurse educator and lactation consultant are also committee members. physicians. children. we have the Perinatal Quality Collaborative of North Carolina for exclusive breastfeeding. One way to accomplish this goal is by reducing the rate of fetal and infant deaths. After discharge the charts are retrospectively audited for safe sleep education and supine positioning at least 24 hours prior to discharge. One inservice was on SIDS and SIDS risks in the term newborn and the other addressed the needs of the premature infant. The Perinatal Quality Collaborative of North Carolina’s well-baby track focuses on supporting mothers’ choice to provide exclusive breastfeeding for their term infants. .” Extensive education was needed for women’s services staff.1552-6909. S40 JOGNN. Outcomes and Evaluation The nurse educator and lactation consultant developed an education program for all women’s services staff. and families. Articles from the literature search were presented. How do you treat a baby with low blood sugar but still exclusively breastfeed? What do you do when a mother is medically unable to breastfeed after birth? What about mothers who want to sleep all night and request that staff bottle feed their infants? What about the obstetrician or pediatrician who tells the mother. Hospital nurses are the ﬁrst professional role models for new parents. Henrico Doctors’ Hospital.org . Beneﬁts of breastfeeding for the mother.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention staff was our new project. RNC.1111/j. An education record is signed at discharge acknowledging that the information was reviewed.Safely Purpose for the Program ne of the Healthy People 2020 goals is to improve the health and well being of women. A little formula never hurt. DOI: 10. such as back sleeping. We became an active member of the Perinatal Quality Collaborative of North Carolina project for exclusive breastfeeding. Henrico Doctors’ Hospital. Nurses are to model safe sleep positioning at least 24 hours prior to discharge and provide parental education on SIDS and SIDS risk reduction. from 2003 to 2007. Implications for Nursing Practice The expectation is to provide consistent safe sleep education to the parents and to model safe sleep positioning. This is reviewed with the parents prior to discharge. S1-S118. parents. Safe sleep education was added to the March of Dimes notebook. Once the infant is transitioned to an open crib. Richmond. it’s the lactation consultant’s job. RN. . In North Carolina. The staff received mandatory in-services regarding SIDS to ensure consistency in parental education. We began with a literature search. 2012. Our council consists of staff nurses from the departments of mother–baby and gynecology. The major health care organizations that recommended exclusive breastfeeding were cited.01360. Implications for Nursing Practice We want to provide the best practice and the literature supports exclusive breastfeeding. “You need your sleep at night. .x http://jognn. and community were discussed. Outcomes. we have power to educate and support mothers and families to make informed decisions about their individual infant’s care. This rate is greater than the national average. infant. As obstetric nurses. Integrating evidence-based ﬁndings into practice will facilitate further involvement into addressing the higher incidence of sudden infant death syndrome in the African American population.awhonn. Data collected will be used to validate success of the program and to encourage the staff continued participation and support. Burrell. SIDS education is also offered at infant cardiopulmonary resuscitation classes. Many examples of hospital practices that decrease success of exclusive breastfeeding were recalled. and Evaluation The safe sleep task force was initiated and a hospital policy on safe sleep was written. It has been proven that supine sleeping is the greatest factor in reducing the risk of SIDS even though many nurses still feel more comfortable placing the baby prone. 41. Richmond. there were approximately 78 infant deaths/year due to sudden infant death syndrome (SIDS). VA Keywords SIDS safe sleep model Newborn Care Poster Presentation Proposed Change Infants are no longer able to have stuffed animals or extra blankets in the incubator or crib. infants. Skin-to-skin care and rooming in were discussed. “Breastfeeding is not our job. and families. which all parents of infants admitted to the neonatal critical care center receive. VA Diane Stairs. Courtnie J. O Implementation.2012. the infant should be placed in a supine position unless a physician’s order indicates otherwise. can be a powerful education tool as well as parental education through verbal and written educational materials. Modeling suggested behaviors. In Virginia. Now I Lay Me Back to Sleep . Implementation.
improved mother–infant interaction. accelerated weight gain. which has more than 200 nurses and staff. Studies have reported beneﬁts of skin-toskin care of the newborn to include reduced crying. Cocoa Beach. Staff nurses were educated in appropriate skin-toskin techniques and patient instruction. MSN. level three. making allowance for individual circumstances and infant condition. Cape Canaveral Hospital. Several studies have come out to support that a cue-based feeding approach.Dohnalek. and Evaluation We introduced a cue-based feeding program in our 83-bed. warmer babies. delivery. can engage in the skin-to-skin care with the infant. C. TX Keywords cue based feeding infant driven feeds NICU feeding Purpose for the Program he purpose of this program was to implement cue-based feeding in our neonatal intensive care unit (NICU). Supplement 1 S41 . also known as an infant-driven approach. T Proposed Change To implement skin-to-skin care in a baby friendly community hospital. A. Heer. and promises long-term beneﬁt to new families. and Evaluation Health First.. BSN. Implementation. Health First Cape Canaveral Hospital.. Ad- ditional positive effects on neonatal self-regulation during the transition from intrauterine to extrauterine life include increased sleep. Families were encouraged to attempt to keep their newborn skin-to-skin for up to 6 hours a day for the ﬁrst week of life and a minimum of 2 hours a day for the second week through fourth week. and. Patient education pamphlets were distributed to women in labor and Kangaroo care shirts were loaned to new mothers during their hospital stay. Outcomes.. An evidence-based practice protocol for placing newborns skin-toskin at birth and in the immediate postpartum period was incorporated into our labor. A chart audit was conducted from 2010 to 2011 for evidence of skin-to-skin care attempted and encouraged immediately after birth and within the ﬁrst hour of life. Inc. BSN. Starrels. and greater breastfeeding success. Metropolitan Neonatal Intensive Care Unit Lindsay Newland. This was JOGNN 2012. The nursing and lactation staff at Cape Canaveral Hospital strive to achieve skin-to-skin care with every new mother–baby couplet. Mothers were assured that anyone. Implications for Nursing Practice The practice of skin-to-skin care as a component of our baby friendly philosophy contributes positively to neonatal transition. Ryan. 41. FL Tracy Lott. L. T Newborn Care Poster Presentation Proposed Change Achievement of full oral feedings is often times the last milestone reached prior to discharge from the NICU. Outcomes. Mothers seen one-on-one in the lactation clinic after discharge are further encouraged to continue skin-to-skin care in the ﬁrst weeks. The staff at Cape Canaveral Hospital has observed anecdotal evidence of these beneﬁts. Many NICUs still used a scheduled feeding method to initiate and progress oral feedings.g. C. improved respiration and oxygen saturation. recovery. ﬁrst in a small group interactive setting and later followed with a video and discussion format. enhances attachment. FL Keywords breastfeeding skin-to-skin care kangaroo care newborn Purpose for the Program o improve mother–infant attachment and breastfeeding. L. IBCLC. indicative of a positive trend in the number of mother–baby couplets opting for this practice and verbalizing their intent to continue skin-to-skin care at home. MS.. Cocoa Beach. Vol. Implementation. and postpartum (LDRP) unit. decreased apnea and bradycardia. RNC. RNC. fathers and grandmothers. M. Level Three. O. Dallas. increased milk production. A cue-based feeding approach tailors the progression of oral feedings for each individual. and of documentation of mother education on beneﬁts of skin-to-skin care. Results show a 90% success rate. RN. launched a skin-to-skin initiative in 2009. Health First Cape Canaveral Hospital. The following outlines our transition from scheduled feedings to cue-based feedings. Howland.. We at Cape Canaveral Hospital are committed to continuing promotion of skin-to-skin care as part of best practice. e. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Implementing Skin-to-Skin Care in a Baby-Friendly Community Hospital Jennifer L. Newborn Care Poster Presentation Cue-Based Feeding: Implementation in an 83 Bed. E. and Wurster. for the mother. with close attention paid to the infant’s developmental cues to decrease stress. metropolitan NICU. may help the NICU infant achieve full oral feedings up to 6 days sooner than a scheduled feeding method. Baylor University Medical Center Dallas. and encouraged during the entirety of the postpartum stay. a Baby-Friendly facility since June 2000. Reeg.
Columbus.1552-6909.x http://jognn.1111/j. Wentworth Douglass Hospital.2012. Fortin. Dover. questions and answers. Rapp. Education included presentations in unit meetings as well as poster presentations. A multidisciplinary meeting took place 6 months after implementation to address concerns and update the program. how to read infant cues. OH Teresa L. Outcomes. Jennifer L.awhonn. Nora C. Heightened awareness of the effects of noise in the NICU promotes an optimal environment for positive developmental outcomes. and unsuccessful breastfeeding. and Evaluation patient satisfaction Informal surveys of patient satisfaction since im. Columbus. we felt that changes needed to be made. anesthesia. DOI: 10. 41. educating parents. RN. Mount Carmel East Hospital.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention achieved with a multidisciplinary team approach. Research is currently underway in our unit to assess time to full oral feedings and the effect on direct breastfeeding rates. how to use a cue-based feeding scale form. and a continuing education offering. including one team leader and four super-trainers on each shift. such as beneﬁts of cue-based feeding. as well as focus groups on each shift. we developed a plan to provide skin-to-skin contact immediately after cesarean births. a nursing policy and guideline. bonding difﬁculties. studies demonstrated higher dissatisfaction with childbirth experiences. RNC-OB. 2012. The proposed change broke the barriers between the traditional Newborn Care Poster Presentation S42 JOGNN. Be Quiet! You Are Getting On My Neurons! Noise Reduction in the Neonatal Intensive Care Unit Purpose for the Program ultiple studies have shown that excessive noise affects neurodevelopment in infants. updates in the unit newsletter.01360. RNC-NIC. Implementation. updates in emails and newsletters. S1-S118. A Keywords skin-to-skin Implementation. Mount Carmel East Hospital. Proposed Change To increase maternal delivery satisfaction. and obstetrics. Based on these ﬁndings. Education was given in the form of bedside in-services. Strategies were implemented by the staff and follow-up monitoring was completed to assess effectiveness. Speciﬁc noise-reduction strategies were proposed by the clinical excellence committee and agreed upon by the staff. and Evaluation Our clinical excellence committee presented education on the effects of excess noise with the sup- Keywords noise neurodevelopment Implications for Nursing Practice neonate Research has shown that the immediate effects neonatal intensive care unit port of the hospital leadership. BSN. and bring about complications in the medical management of the neonate. NH plementation have been positive. After implementation. Implications for Nursing Practice This new service is an example of how nurses are empowered to question tradition to advocate for their patients. Future research to consider is the effect that cue-based feedings has on oral aversion after discharge. NNP-BC. Notestine. and trouble shooting. OH of elevated levels of sound show that environmental noise can be a major source of stressful stimulation. BSN. Implications for Nursing Practice Cue-based feeding has become a common language in our unit and is considered a success. can cause agitation. Outcomes. Our ﬁndings were that our levels exceeded recommended levels. Staff education was given by nurses. Women giving birth by cesarean are more prone to postpartum depression. pediatrics. M Proposed Change We provided education on the effects of excess noise on neonates to our NICU staff and implemented noise-reduction strategies in an attempt to decrease our overall noise level.neonatal thermoregulation surgical environment and the delivery room and required collaboration between the departments of surgical services. Newborn Care Poster Presentation Exploring New Frontiers: Providing Skin-to-Skin Contact for Mothers and Newborns during Cesarean Birth Purpose for the Program s cesarean birth rates increased in the United States in response to the American College of Obstetricians and Gynecologists’ statement concerning vaginal birth after cesarean. Concerns and common issues were addressed in the form of bedside in-services. bedside charts were audited to assess staff adherence with cue-based feeding and address issues. The education ranged in topics.org . A more formal evaluation of the process will include a review of newborn thermoregulation in the operating room and a postpartum survey of patient satisfaction. Our clinical excellence committee wanted to explore the noise levels in our neonatal intensive care unit (NICU).
It was decided that the differing needs of these infants from full-term newborns could be provided for in a virtual setting. After looking at the average length of stay. Implementation. TX H face when providing milk and discovering an innovative game plan to reduce those barriers. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Mom’s Own Milk Bundle: Increasing Supply in an 83 Bed. Baylor University ospitals are encouraged to step up Medical Center at Dallas. Each year since implementation. which both recognize the protection and value of mom’s own milk. Proposed Change The MOM Bundle uses quality initiatives throughout the Women and Children’s Service line to initiate and maintain the mother’s milk supply. protocols established. Outcomes. N. and NICU support staff. Supplement 1 S43 . Having the infant in close proximity increases the time available for educating the mother about the unique needs of the special care infant and allows her to feel an increased sense of conﬁdence when taking the infant home. Keywords breast milk NICU quality initiatives collaborative increasing milk supply Newborn Care Poster Presentation tiatives. 83-bed. Purpose for the Program IBCLC. The use of human donor milk in the neonatal intensive care unit (NICU) has been expensive but worth the payoff with less very low birth weight morbidity and mortality in our large NICU. decrease medical and surgical necrotizing enterocolitis rates. number of donor milk bottles used each day. The team estimated that within 24 hours after birth. JOGNN 2012. Improvements are focused on the barriers mothers Virtual Special Care Nursery: A Cost Savings Idea Michelle M. Working together with our medical. This process increases the nursing staff’s satisfaction about the care they provide. which beneﬁts the mother. MSN.Fortin. Purpose for the Program RNC-OB. The average length of stay for the special care infant was 7 days. Newborn Care Poster Presentation Proposed Change A majority of infants born 35 to 36 6/7 weeks of gestation and infants born to mothers who were diabetic and insulin-dependent were admitted to the neonatal intensive care unit (NICU) for monitoring within 24 hours of birth. Nurses would be trained following evidence-based guidelines. Christina Conner. C. Baptist Health. AR Keywords special care length of stay late preterm infant T ery is to decrease the length of stay for these patients while maintaining quality care. such as The Joint Commission Perinatal Core Measures and Baby Friendly Hospital Initiative. and Evaluation Over a 6-month timeframe. equipment purchased. nursing. Vol. Implications for Nursing Practice The MOM Bundle is a collaborative approach to increase the availability and volume of mothers’ milk in our Level III. approximately 75% of late preterm infants were admitted to the NICU prior to the implementation of the special care nursery. our goal is projected to decrease donor milk use. BSN. Outcomes. and decrease length of stay. and ﬁscal expenditures spent on donor milk. and Evaluation Implementation of this quality initiative focuses on staff and family education. baseline breastfeeding rates. Little he purpose of the virtual special care nursRock. we project an increase in mom’s own milk. Implications for Nursing Practice Nursing staff in the special care nursery are trained to evaluate and intervene quickly based on evidence-based protocols. McFail. the number of admissions to the NICU has decreased for this population. Implementation. the infant. The purpose of the Mom’s Own Milk (MOM) Bundle is a multidisciplinary. NICU. The care would be provided in the mother’s room or the well-baby nursery. Neonatal Intensive Care Unit E. evidence-based practices with various iniDallas. and a plan was implemented to care for the special care infant on the postpartum unit. the admissions had decreased to 9%. After 6 months of implementation. information was gathered. RN. Level III. This allows for the infant to remain with the family. The length of stay has decreased from 7 days to approximately 2 days for this group as well. collaborative approach to gently encourage and support a mother’s decision to provide her precious milk for her baby in the NICU. 41. and the hospital goals.
University of Minnesota Medical Center. and initiated procedures (weight. Based on the test results. comfort care or pursue neonatal intensive care intervention. decreased overall costs. MN Keywords comfort care palliative loss newborn life-limiting fetal Newborn Care Poster Presentation http://jognn. Furthermore. and informed parents of required follow-up. Outcomes. pregnancy. and promoted better outcomes for the patient. Chicago. Minneapolis. Parents received an information form with the follow-up appointment to the Bili Clinic (scheduled anytime from 8:00 a. or serum bilirubin) as requested. We sought to identify infants at risk and streamline the evaluation and treatment process by instituting a weekend and holiday Bili Clinic on the mother-baby unit.org S44 JOGNN. the decision was made to provide further patient follow-up. Chicago. to 4:00 p. E Proposed Change Previously. University of Illinois Medical Center.m.x .awhonn. RN. maintained a logbook. we instituted collection of cord blood type and Coombs testing at delivery for mothers with blood type O positive or RH negative blood types. CNP. BSN. During the week. transcutaneous bilirubin. The weekend and holiday Bili Clinic opened in April 2010. emotional. IL Lourdes Notario. or admit the newborn for treatment.). multidisciplinary program that provides a continuum of medical. which delayed evaluation and treatment. S1-S118. P Proposed Change The University of Minnesota Amplatz Children’s Hospital’s Perinatal Palliative Care is a familycentered. newborn health care providers (from the departments of pediatrics or family medicine) identiﬁed newborns requiring outpatient follow-up on the weekend and holiday and initiated the process for pre-admission to the Bili Clinic. BSN. and spiritual support through diagnosis. Throughout this process.2012. The goal was to identify those at risk of hyperbilirubinemia and initiate treatment in a timely manner. The program goals address the National Quality Forum’s Preferred Practices for Palliative Care and support caregivers in meeting palliative care outcomes. DOI: 10. bin test performed and if the result was greater than 6 a serum bilirubin specimen was collected. Martha Montes.01360. University of Illinois Medical Center. Implications for Nursing Practice Evaluation is ongoing based on patient comments and efﬁciency of workﬂow for nursing staff. psychosocial. The American of Academy of Pediatrics has instituted guidelines for the assessment and management of hyperbilirubinemia in newborns. discharged infants with hyperbilirubinemia who required follow-up on weekends and holidays were seen in the emergency room. This process for at-risk infants bypassed the emergency department and facilitated prompt treatment at the Bili Clinic. The program offers a formalized care process for families choosing to continue the pregnancy and utilize comfort care for their newborn at the time of birth. The purpose of this project was to develop an innovative approach to identify newborns at risk of hyperbilirubinemia at delivery and at 24 hours of life and to improve neonatal outcomes for at-risk infants with hyperbilirubinemia after discharge during the weekend and holiday. Infants received phototherapy in a timelier manner and thus increased patient and nurse satisfaction.1552-6909. 41. RN. Becky Gams. treatment options with second opinions or withdrawal of life sustaining measures. birth. MS.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Two Phase Innovative Approach for Newborns at Risk of Hyperbilirubinemia Purpose for the Program ach year approximately 60% of the 4 million newborns in the United States receive a diagnosis of clinical jaundice. parents are supported in creating a plan of care for their baby that is consistent with their goals and wishes. all newborns after 24 hours of life had a transcutaneous biliru- Operationalizing Palliative Care Processes through a Perinatal Palliative Care Program Purpose for the Program arents who receive a life-limiting fetal diagnosis face many unexpected decisions: continue the pregnancy or proceed with early termination.m. notiﬁed the newborn health care provider of the newborn’s arrival. Most infants with hyperbilirubinemia who are discharged before 72 hours should be seen within 2 days of discharge. the staff activated the Bili Clinic process. and death. discharge home. 2012. As parents arrived for followup. RN. IL Keywords hyperbilirubinemia phototherapy transcutaneous bilirubin (Tcb) Bili clinic Newborn Care Poster Presentation Implementation.1111/j. Fairview. and Evaluation To identify infants at risk.
interviews with leaders from established programs. care conference documentation. RN. 2011. Purpose for the Program RNC-LRN. From initiation of the project on October 1. from May 2010 to April 30. However. JOGNN 2012. to February 28. The Western logic intervention is necessary and/or effective. development of support from hospital administration and key individuals willing to operationalize the program. as the newly established Fetal Diagnostic and Treatment Center’s patient volume grew. Proposed Change A baby cuddler is a trained baby holder who can ﬁll the gaps when parents are not able to be present. baby cuddlers have contributed 2. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Implementation. program access. and Evaluation Seventy-ﬁve infants were admitted to the department with the diagnosis of NAS in the 1-year study period from May 2009 to May 2010. Baby Cuddlers Make a Difference Monica C. averaging four per year from 2008 to 2010. A detailed birth plan template. led by the advanced practice nurse leader. Implementation. included a literature review. Kraynek. the needs for families choosing to continue pregnancy and newborn comfort care were expected to grow as well. B. The creased more than 150% since 2004.855 hours of cuddling to patients suffering from NAS.4 days. 2009. the average length of stay for infants with NAS was 26. and Evaluation Historically. thus. and multidisciplinary education will be described. Although current numbers are small. and process workﬂow will be displayed.Gams. Implications for Nursing Practice Nurses have implemented a low-cost intervention that decreases length of stay and. 2011. PA T for neonatal abstinence syndrome (NAS) has in- Mona Patterson. RN-BC. care for these families was heroically pulled together by a few dedicated and passionate individuals. The he number of newborn infants treated every Western Pennsylvania Hospital.3 days compared with the initial noncuddler group. as a unit evidencebased practice project. year at the Western Pennsylvania Hospital Pittsburgh. Program scope.2 days without the baby cuddler program. the average length of stay for infants with NAS was 22. a decrease in length of stay of 2.” Data from patient satisfaction surveys and multidisciplinary debrieﬁngs are disseminated to the health care team.8 days. BSN. was to learn if the addition of baby cuddlers as caregivers could affect the length of stay required for treatment of these infants. Supplement 1 S45 . Nurses conWestern Pennsylvania Hospital. drawal symptoms and determine if pharmacoMSN. Implications for Nursing Practice The Perinatal Palliative Care program offers this care model within an institution with an established pregnancy and newborn loss program and a recently established Fetal Diagnostic and Treatment Center. a decrease in length of stay of 3. Baby cuddlers completed an orientation to their role and received education on hand washing and Health Insurance Portability and Accountability Act regulations. MBA. role deﬁnitions. eight families were served in 2011 (year-to-date). newborn comfort care orders. After the ofﬁcial evidence-based project ended. and comforted the infants suffering from drug withdrawal.9 days. Outcomes. PA Keywords baby cuddler neonatal abstinence length of stay Newborn Care Poster Presentation medication. From November 2009 to May 2010. the pediatric unit cared for an additional 75 NAS patients. The importance of human contact and touch in the well being of all hospitalized infants has been well documented. Outcomes. Families commented that “this was the happiest and saddest day of my life. 41. From May 2009 to October 2009. Length of stay was compared from the ﬁrst 6 months without the baby cuddler program to the last 6 months after the initiation of the program. MS. a broad health care team accommodates the individual needs and circumstances of each family in the program. responsibilities for maternal and neonatal medical management. Vol. The purpose of the program. The palliative care approach is enhanced by our established Pregnancy and Newborn Loss program. and creation of a multidisciplinary education process. duct the Finnegan Neonatal Abstinence Scoring Pittsburgh. Pennsylvania Hospital. Interventions for treatment of these infants include medication and supportive care. RN. affects hospital ﬁnances and provides quality patient care to a vulnerable population. The cuddler provides an important component of the developmental care for the hospitalized infant. PA Tool every 2 hours to analyze the infant’s with- Christina Westbrook. BSN. The length of stay average was 23. Baby cuddlers on a daily basis held. Up to 30% of infants may be managed without Pittsburgh. Within this supportive formalized structure. Steps to formalize the program. rocked.
born to mothers with chorioamnionitis or diabetes who received IV insulin during labor. newborn care guidelines including revision of newborn order sets were established. breastfeeding. DOI: 10.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Normal Newborn Nursery – Neonatal Intensive Care Unit: What’s in Between? Purpose for the Program trend of term newborns requiring transfer from the newborn nursery to the neonatal intensive care unit (NICU) was identiﬁed in a Level III NICU at a Magnet hospital. MS. Nurses are critical to assess. and the transfer of all newborns back to the mother–baby unit is about 80%. BSN. Lehigh Valley Health Network. Implementation. Implications for Nursing Practice Clinical criteria to identify newborns at risk of instability during extrauterine transition of life were standardized and embedded into practice. Standard processes and care requirements enabled nurses in a NICU to make prudent and timely decisions to improve neonatal outcomes. families were made aware of where their newborns would be admitted. Lehigh Valley Health Network. 41. RNC-NIC. Scripting to parents and families were created. the incidence of newborns experiencing hypothermia and hypoglycemia during the transitional period was reduced by changing the focus of unnecessary interventions. Allentown. and Evaluation To review the current practice and identify the prioritization of the nursing task over the outcomes of bathing. Outcomes. Baycare/Saint Joseph’s Women’s Hospital. Schulz. and Evaluation A collaborative team approach was taken to establish clinical criteria to identify infants at risk of transfer to the NICU. PA Denise Keeler. 2012. These infants. T Proposed Change To improve newborn outcomes. Baycare/Saint Joseph’s Women’s Hospital. high-risk transition newborns. Standards were developed for newborns delivered between 35 and 36 weeks gestation. Glucose management. Diana V. algorithms. The criteria were communicated to the family prior to delivery to ensure inclusion with all aspects of care. Implementation of bath delay showed that regardless of gestational age. BSN. are admitted to the NICU for up to 6 hours of observation. which included the development of crib cards in order for clinical staff to facilitate the process change by direct hands-on education. and evaluate care for high-risk transition newborns to improve clinical outcomes and increase efﬁciency. Implementation. Allentown. To foster family-centered care. and newborn admission policies were revised to reﬂect new processes. Tampa. implementation of evidence-based research was initiated. These criteria provided necessary collaborative nursing and medical management of the newborn patient care for the newborn nursery registered nurse and the primary care pediatrician. Lipka. and reference cards.1111/j. Improved quality outcomes for the newborn and improved patient satisfaction are a direct result of a standardized plan of care for high-risk transition newborns. RNC. full-term hypoglycemic newborn transfers decreased 15% from the mother–baby unit to the NICU. plan.org . act. the admission of high-risk transition newborns to the NICU increased 27%. Multidisciplinary team actions involved evidence-based practice data regarding the effectiveness of newborn bath delay. PA Keywords transitional NICU transitional newborn nursery observational nursery Newborn Care Poster Presentation “Wait for Eight”: Improvement of Newborn Outcomes by the Implementation of Newborn Bath Delay Purpose for the Program o improve newborn outcomes by implementing the evidence-based research to delay bathing the newborn.01360. Outcomes.x http://jognn. including process ﬂow charts. the newborn. Reference to evidence-based research and data collection post-implementation of guidelines were utilized. Judith Pfeiffer. FL Keywords newborn bath delay skin-to-skin transition Newborn Care Poster Presentation S46 JOGNN. FL Marcia K. Tampa. RNC. S1-S118. Since July 2008. RN-C.awhonn.1552-6909. This offering will detail the pragmatic strategies utilized to decrease NICU admissions of high-risk transition newborns and present speciﬁc obstetric-related diagnoses. Clinical autonomy was maintained for the NICU nurse who provided care to the newborn during the transitional time frame. The criteria and interventions were standardized and embedded into practice. BA. A Proposed Change To develop standards in clinical practice to promote newborn stabilization speciﬁc to newborns delivered between 35 and 36 weeks of gestation. born to mothers with chorioamnionitis or diabetes who received intravenous (IV) insulin during labor.2012. A multidisciplinary approach was utilized to assure all care providers involved with maternal–newborn care received education.
To improve newborn outcomes. which promotes feeding tolerance. Supplement 1 S47 . It also has been proven to protect against gastrointestinal and respiratory infections. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention The description of the process from admission to discharge identiﬁed the value in bath delay related to skin-to-skin research. MSN. Recognition of the importance of an uninterrupted newborn transition resulted in positive newborn outcomes and patient satisfaction. RN. Purpose for the Program RNC-NIC. Implementation. and breastfeeding was emphasized. Mission Hospital System.500 grams) was developed and implemented in January 2011. Our efforts were validated by the improved outcomes of practice change of newborn bath delay. Currently. 41. The need to review one such practice was the newborn bath. Proposed Change The nursing intervention of buccal application of a mother’s colostrum potentially decreases the incidence of certain morbidities and decreases the length of stay of these fragile infants. The research of skin-toskin practice directly correlated the need to review newborn care and practices thereof. This population of patients in the neonatal intensive care unit (NICU) is most vulnerable to morbidities. the incidence of newborns experiencing hypothermia and hypoglycemia during the transitional period was reduced by changing the focus of unnecessary interventions. NC T Jennifer Wilkinson. posed change in practice is to institute a policy of buccal application of colostrum in the NICU. Asheville. Mission here is overwhelming evidence in the literature Hospital System. NC Keywords low birth weight babies breast milk NICU buccal care Newborn Care Poster Presentation that human milk is superior to any form of nutrition for the neonate. and developmental properties that prevent infection. The infants are being followed longitudinally for outcomes related to this care. The pro- JOGNN 2012. Its perfect combination of protein. and Evaluation A protocol for the buccal application of a mother’s colostrum as well as banked breast milk for all low birth weight infants (weighing less than 1. Global hospital staff education was initiated and staff were presented with advice to give to parents and families during newborn care education. The initial review of charts since the start of this policy revealed that access to colostrum takes several days and adherence to the policy is varied. Implications for Nursing Practice Historical review of newborn care delivery demonstrated that nursing has shown to place priority on the completion of nursing tasks over the outcomes related to the newborn transitional period. provide individualized nutrition. IBCLC. Implementation of bath delay showed that regardless of gestational age. including necrotizing enteral colitis and nosocomial infections. The value of skin-to-skin care with transition. Staff education was completed at staff meetings via slide presentations. Implications for Nursing Practice Due to the limited availability of colostrum. K. Vol. The completed policy also includes an education sheet for parents as a means of encouraging their participation in this bedside practice. The purpose of this project is to promote buccal application of mother’s colostrum for low birth weight infants in the NICU. bonding. Ongoing education of staff and parents is imperative to the successful implementation of this policy. V. and optimize brain growth and visual development. mothers are being encouraged to begin pumping within 6 hours of delivery and pump on a prescribed schedule. longitudinal data are being collected on the infant outcomes posttreatment. Buccal Care with Colostrum in the Low Birth Weight Infant Kimberly Pinkerton. We created syringe kits with detailed instructions for the collection of a mother’s breast milk to avoid waste. Human milk decreases the incidence and severity of nosocomial infections and necrotizing enteral colitis. It contains immunological. nutritional. Outcomes. implementation of evidence-based research was initiated to foster practice change. and plasma proteins improves gastric emptying. Recent studies have proven that the protective factors in colostrum are even more concentrated in the colostrum of women who deliver low birth weight infants. and Schulz. which resulted in increased patient satisfaction. carbohydrates. D.Lipka. RNC-NIC. BSN. Asheville. M.
a 67% decline. BSN. Sharp Mary Birch Hospital for Women & Newborns. Staff and patient education were developed utilizing the ﬁndings from incident reports. Picture-based patient education was developed and posted in patient rooms for easy access by patients and visitors. Three falls occurred in 2010 prior to the implementation of staff and patient education. (h) random audits. MBA.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Don’t Drop That Baby! Purpose for the Program he purpose of this poster is to share information regarding the incidence of falls of infants. Implications for Nursing Practice A comprehensive program of central line management.341 live births as of June. The patient education posters were translated into Spanish. C tion and dressing changes.83 falls per 10. Implementation. 2012.awhonn. consideration should be given to utilizing pictures in addition to text. and (i) development of a standardized sterilized PICC dressing change kit. there were 0. (b) development and implementation of central line insertion and maintenance bundles. random audits. as well as to explore future plans for decreasing the rate of falls of infants at the maternal infant services unit at Sharp Mary Birch Hospital for Women & Newborns. patients at Sharp Mary Birch Hospital for Women & Newborns originate from a variety of countries and speak many different languages. there were no falls for nearly a year. and Evaluation Strategies included the following: (a) hand hygiene. ARNP-BC. RD. DOI: 10.5 falls per 10. 41.000 live births (8. The CLABSI rate for 2010 was 3.000 live births.000 live births (4. however. CLABSI rates in the NICU decreased progressively from 10. CLABSI can be signiﬁcantly reduced and in some cases completely eliminated. Joseph’s Women’s Hospital’s NICU began reviewing central line care and the current literature concerning best practices for central line management.01360. and Evaluation Focused staff and patient education were implemented in April 2010. Implementation.37 per 1000-catheter days. (e) standardized central line tubing change policy. T 2.org . Implications for Nursing Practice The success of patient education may be attributed to the goal of educating the patients and visitors as well as providing education to illiterate or non-English speaking patients. is effective in signiﬁcantly reducing CLABSI in the NICU. MSN. At the time of this abstract submission.2012.1111/j. Tampa. Sharp Mary Birch Hospital for Women & Newborns. FL Keywords central line associated blood stream infections quality champion central line bundle hand hygiene random audit neonatal intensive care unit Newborn Care Poster Presentation Proposed Change A comprehensive program was developed. Jayne Solomon. RN. RN. From the implementation of education. Outcomes. motivating and communicating with the team. a designated committee at St. To optimize comprehension of patient education. The number of bloodstream infections decreased from 30 in 2009 to 10 in 2010. (c) validation for a team of nurses to perform peripherally inserted central catheter (PICC) inser- S48 JOGNN. the education strategies employed to decrease the risk of falls. San Diego. In June 2009. led by a quality champion. CA Keywords falls of infants health literacy cultural barriers staff education Proposed Change Investigations were completed to identify trends in the falls of infants.x http://jognn. In 2009. Outcomes. and in 2010 there were Newborn Care Poster Presentation Reducing Catheter Associated Bloodstream Infections in the Neonatal Intensive Care Unit: Challenging Nurses to Be Champions Purpose for the Program entral line-associated bloodstream infections (CLABSI) are associated with increased mortality and adverse outcomes in multiple systems in the neonatal intensive care unit (NICU) patient.84 per 1. San Diego. All of the literature in the past 2 years regarding CLABSI has shown that with the implementation of evidence-based strategies. and gathering surveillance data for quality improvement. The designation of a quality champion who is responsible for the initiative is vital to the success of this program. S1-S118. and a timeline was established to implement multiple interventions into the unit’s guidelines for the management of central lines. 2011). CA Monika Lanciers. St.568 live births in 2010). This role includes overseeing and participating in staff education. (f) daily audits of all central lines for integrity and necessity.000-catheter days just before the initiative begun in June 2009 to 5. Ellen Fleischman.17 per 1. Joseph’s Women’s Hospital. there were 5.43 falls per 10. (g) “scrub the hub” care.000-catheter days by the end of the year. (d) competency validation for all staff performing central line blood sampling.1552-6909.
BSN. KY Susanna Bowen. also three staff members received certiﬁcation in Kangaroo care. Kangaroo care champions were identiﬁed and assisted other staff with completion of Kangaroo care competencies. This quality initiative is being shared with 57 birthing hospitals throughout Kentucky. a national evaluation of Close to Me was conducted in four NICU sites using an outside consultant who conducted staff focus groups and surveys preintervention and postintervention. Implications for Nursing Practice Implementation of the Kangaroo care initiative improved breastfeeding rates in the population served by the ULH. However. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Kangaroo Care Increases Breastfeeding Rates Kim Bagby. as a way to keep infants warm and provide optimal nutrition following birth. or skin-to-skin contact. including increased breast milk supply and greater breastfeeding success. RNC. Proposed Change The Close to Me intervention includes parent education and awareness materials. Columbia. Implementation. RN. Implementation. JOGNN 2012. Strategies were developed to hardwire the process and facilitate a change in practice that supported the use of Kangaroo care. PCE. began in 1979 in Bogota. The percentage of mothers and infants documented as participating in Kangaroo care in the mother–baby unit also increased from 35% to 51%. White he national evaluation results of the March Plains. Cooper. In 2011. Ninety percent of the labor and delivery staff and mother–baby staff completed the Kangaroo care competency assessment in the 12 months following July 2010. Breastfeeding initiation rates increased from 51% in July 2010. policies were revised. Supplement 1 S49 . BSN. KY Keywords kangaroo care skin-to-skin contact breastfeeding barriers to kangaroo care Purpose for the Program or eligible mother–infant dyads. Louisville. Staff respondents also reported the beneﬁts of Kangaroo care include reduced stress. Outcomes. Our journey continues with further education and improved practices. does implementation of Kangaroo care at birth increase breastfeeding rates compared to retrospective breastfeeding rates? F Newborn Care Poster Presentation Proposed Change Kangaroo care. and Evaluation Close to Me was unveiled in March of Dimes NICU Family Support R program sites nationwide. Breastfeeding and Kangaroo care progress was shared monthly with staff. It is essential that all levels of leadership support and monitor standard of care practice at the bedside. University of Louisville Hospital. LMSW. Documentation was improved to facilitate accurate data collection.Bagby. and staff expectations for participation were established. a Kangaroo care program for healthy infants and their mothers at the University of Louisville Hospital (ULH) was implemented. K. but only 8% of staff reported routinely offering Kangaroo care to families. March Purpose for the Program of Dimes Foundation. In 2007. and increased parent–infant bonding. This presentation will share the components of the Close to Me intervention as well as what was shown to be most effective in the evaluation. University of Louisville Hospital. staff education materials. and Bowen. The March of Dimes developed the Close to Me intervention to increase the early onset and frequency of Kangaroo care in NICUs. The Perfect Pouch: A March of Dimes Intervention to Enhance Onset and Frequency of Kangaroo Care Liza G. Louisville. to 74% in July 2011. The American Academy of Pediatrics recommends skin-to-skin contact as a strategy to increase breastfeeding success. In addition. S. PCE. Staff accountability is crucial to any successful change in practice. Outcomes. Research has shown that Kangaroo care has many beneﬁts for mothers and infants. NY Keywords Kangaroo Care skin-to-skin staff resistance parent awareness T Newborn Care Poster Presentation of Dimes NICU Family Support program revealed that neonatal intensive care unit (NICU) parents felt that the most comforting activity that could be offered in the NICU would be to hold their infants. enhanced comfort. and items of comfort and encouragement for families. During this time the percentage of eligible infants who were placed in Kangaroo care at birth increased from 60% to 73%. and Evaluation Current literature was examined. the philosophy was not adopted as a standard of care until 2010. accurate data collection and a comprehensive educational program are vital to support the initiative. Vol. 41.
Outcomes. the staff members were educated through the creation of a six-panel poster session on the policy. The physiological. which holds parents to the same standards as the nurses and doctors. These teams compiled input. MSN-CNL. DOI: 10. Results will be shared regarding the most effective components of Close to Me and the changes in parent and staff perceptions from preintervention to postintervention. S1-S118. including fullterm babies and those in the NICU for a short stay. and a special parent journaling technique. Carson. and hands-on instruction. This project was completed as follows: the California Children’s Quality Initiative guidelines were collected and incorporated into the current infection control policy for the unit. 41. A New Look At Infection Control in the Neonatal Intensive Care Unit Purpose for the Program o reduce infection rates in the neonatal intensive care unit (NICU) by 30%. continuing to complete audits on practice. and emotional beneﬁts of Kangaroo care are worth the additional time required in educating staff and providing comforting space and opportunities for parents to Kangaroo care their infants.1552-6909. Parents can learn to ask for and advocate for this activity if they know about it and its beneﬁts early in their baby’s hospitalization. Key ﬁndings from this work also will be discussed. the last 5 years of peer-reviewed literature on infection control pertaining to neonatal intensive care was reviewed. T proved by the medical director and delivered to Michele L. Implications for Nursing Practice Kangaroo care is a proven beneﬁt to newborns and parents.awhonn. and the information was added as appropriate to the policy. CA Keywords NICU CLABSI quality initiative Proposed Change To educate and implement policy to reduce the NICU infection rates. We are accomplishing this by reviewing current evidence-based practice yearly and changing practice accordingly. 2012. and pertinent information was added to the policy and procedure. Each staff member was required to walk through the poster session and answer a set of competency questions that pertained to the poster session. medical. Implications for Nursing Practice At this time our efforts are focused on sustaining the gains.2012. speciﬁc audit tools were used to assess staff adherence to the components of the policy. the policy was reviewed and ap- Once the policy was ﬁnished. These data were presented to the 2009 California Perinatal Quality Control Collaborative annual meeting in Sacramento and at the hospital-wide infection control committee. This project was started in July 2008 after the unit joined the California Children’s Quality Initiative in January 2008. well-baby audiences of professionals and parents. During this time. and providing continuing education to new and current staff. and each multidisciplinary group in the NICU was met with (for example the peripherally inserted central catheter team).x http://jognn. Researching Kangaroo care by having parents maintain a journal is appealing to parents who have the opportunity to heal and process as they participate in the study. the aim of this project was to recreate the policy and procedure on infection control for the NICU. Newborn Care Poster Presentation S50 JOGNN. UCSD Medical the core group for the unit. and Evaluation To change the way we look at preventing infections in the NICU. Del Mar. We worked closely with a large team of NICU staff on adapting our materials for the full-term NICU infants and the full-term.01360. Staff resistance to its implementation can be overcome with awareness. the infection rate was reduced by 58% and audit data showed adherence to be at 96% and greater. Center. each policy concerning infection control was reviewed.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention parent surveys. Overall.1111/j.org . Implementation. The initial goal for 2008 was to reduce infection rates in the NICU by at least 30%. education. Finally. RNC-NIC. Kangaroo care can be vital to many if not all babies in the NICU. The policy was approved by the hospital-wide infection control committee and is under review for adoption on other hospital units. Also. a parent agreement was created that centered on infection control.
In addition. the postpartum registered nurse (RN) would alert the RN nurse when the mother had taken pain medication.Woodson. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention What Do You Mean You Dropped Your Baby? Changing and Hardwiring Nursing Practice to Eliminate Infant Falls Linda Woodson. Finally. Outcomes. I Newborn Care Poster Presentation Proposed Change Our goal was to eliminate infant falls at Andrews Women’s Hospital. BSN. Supplement 1 S51 . Our goal was to inskin to skin early pumping crease the rates of breast milk feeding during the exclusive breast milk feeding duration of the hospital stay and the rates of infants easy access for rental supplies who were exclusively fed breast milk at discharge to promote what is best for infants and comply with the the Joint Commission’s recommendation. In addition. and to promote maternal rest. TN B Newborn Care Poster Presentation Proposed Change Our plan was to increase the support and duration of exclusive breast milk feeding by placing infants skin-to-skin during the immediate post delivery period. we planned to begin encouraging early pumping for mothers of infants that were not breastfeeding well or were unable to nurse. We began an extensive campaign to make sure that the mothers understood the adverse effects of pain medication. RN. This was accomplished by partnering with a pharmacy in the Bristol Regional Medical Center to provide easy rental of breast pumps as well as breastfeeding supplies at competitive prices. supported by the American Academy of PediBristol Regional Medical atrics for the ﬁrst 6 months of life. Finally. we educated our nursing staff on the importance of supporting breastfeeding. which has been shown to increase the success of breastfeeding by approximately 80%. RN. the Center. The proposed changes were to hardwire hourly rounding on all shifts. we developed a newborn safety sheet that described the elements of safe sleeping and re- quired that both the mother and the signiﬁcant other sign the sheet because three infants had been dropped by fathers. Supporting Breastfeeding in the Hospital: A Better Start Purpose for the Program reast milk feeding is the best option for infants and exclusive breast milk feeding is Maggie Redmon. The outcome has been very positive. Baylor All Saints Medical Center. allowing them to become breastfeeding advocates for our patients. even when she is placed in a chair. We began placing all breastfeed- ing infants skin-to-skin within the ﬁrst hour and allowed them to self-attach to the breast for the ﬁrst feeding. CLC. recommending exclusive breast milk feeding during Keywords an infant’s entire hospital stay. Bristol. JOGNN 2012. we were able to provide the early intervention and support necessary for our patient population. Our staff would then be educated on the changes. TN Joint Commission recently introduced PC-05. and Evaluation Our unit began implementing changes to support the breastfeeding relationship in the above mentioned areas. Next. RN. Implementation. and it has been 1 year since the last fall of a newborn occurred. Second. TX Keywords education newborn safety sheet snuggle time hourly rounding Purpose for the Program n the ﬁrst 2 years that Andrews Women’s Hospital was open. Then. Combining these interventions has a great potential to increase the rates of exclusive breast milk feeding during the hospital stay and beyond. Patients are excited about the skin-to-skin process and our early support and intervention. Bristol. we experienced eight infant falls. Fort Worth. Second. we initiated “snuggle time” every day from 2:00 to 4:00 to promote maternal rest without interruptions. Implementation. 41. Implications for Nursing Practice Education of families and hourly rounding are absolutely necessary for keeping our infants safe. Tessa Brown. In addition. Implications for Nursing Practice By implementing these changes. to educate families on safe sleeping arrangement. BSN.Andrews Women’s Hospital. and Evaluation We implemented the project by ﬁrst using a tally sheet to identify common trends that occurred in the falls of newborns. We then planned to make breast pumps and supplies more readily available for our patients. we began to encourage early pumping for infants that were not feeding well at the breast or were unable to be at the breast because of medical conditions. we emphasized with the newborn nursery staff and postpartum staff how important it was to make sure that the mother has the call bell within reach. Outcomes. Bristol Regional Medical Center. We then looked at how we could support the use of breast pumps for our patient population. L. Our partnership with the pharmacy has allowed our patients easy access to breast pump rentals and supplies. C-EFM. Vol. we educated both the newborn nursery and the postpartum staff on the need to hardwire the hourly rounding on all shifts.
and supported thermal regulation of the newborn. which is viewed by many as necessary for the infants’ survival. and Evaluation A multidisciplinary team was formed that consisted of labor and delivery nurses. receiving only conﬁrmatory results. our obstetric nurses created a seamless process to keep the mother and infant together throughout the challenging postoperative period. accuracy in patient test results is crucial. In collaboration with our post-anesthesia recovery team. 41. and supports the Association of Women’s Health. fosters teamwork between nursing units. Evidencebased best practice was used to guide staff education. but be- cause of false positive test results and the length of time to obtain conﬁrmatory results it was identiﬁed that a practice change was necessary. A positive maternal test result determines the initiation of the protocol to test newborns. The advantages of this process included samples being sent immediately after birth. RNC. the roles and responsibilities of the labor and delivery nurses were changed. Milford Memorial Hospital-Bayhealth. A process was developed to assist with the implementation of the new procedures and to educate and direct nursing teams involved with cesarean births. 2012. Johnson City. R Proposed Change Meconium drug screening is considered the gold standard for drug testing in the neonate. allowed skin-to-skin contact. This team was formed to change the policies and procedures to allow infants to remain with their mothers after a cesarean birth and the immediate postpartum surgical recovery period.x http://jognn. Increase in false positive test results lead to questioning the truthfulness of the test. and the director of women’s services. RNC-OB. newborns are placed naked on their mothers’ chests immediately after birth. Outcomes. Bonding and Breastfeeding in the Post-Anesthesia Care Unit: Innovative Family Centered Care in a Community Hospital Purpose for the Program n many cultures.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Babies. Milford. These changes enable the nurse to be off of the labor and delivery ﬂoor and provide both intraoperative and postoperative one-on-one care for the newborn and mother as a unit. Evaluation revealed that keeping the mother and baby together after cesarean birth increased patient satisfaction. Implications for Nursing Practice Implementing “Babies. Lauren Grifﬁn-Walls. Facilities should establish their own testing protocols and unbiased guidelines to identify when testing should occur because the literature does not indicate consensus on universal screening.org .2012. universal testing in high-risk populations indicates higher rates of illicit drug use. The education incorporated the importance of skin-to-skin contact between the mother and baby and early breastfeeding after an operative delivery. and a chain of custody. The goal was to identify a process that provided ease of obtaining specimen sampling and accurate patient test results. Milford Memorial Hospital-Bayhealth. postanesthesia recovery team members. BSN. Milford.awhonn.1111/j. FNP-BC. RN-CPN. In most community hospitals. I Proposed Change In an effort to provide immediate skin-to-skin contact and allow for early breastfeeding for mothers and their healthy infants after operative deliveries. Because of the sensitive nature of this test. however. Implementation. mothers and infants are separated quickly after cesarean birth and not reunited until hours later. MSN. and Breastfeeding in the Post-anesthesia Care Unit” enhances overall postpartum operative care. DE Jaclyn Lewis. DOI: 10.1552-6909. Bonding. S1-S118. a chain of custody Tanyelle Bellamy. The proposed change was to implement umbilical cord tissue screening. TN Keywords drug testing substance abuse umbilical cord testing neonatal abstinence scoring Newborn Care Poster Presentation S52 JOGNN.01360. Obstetric and Neonatal Nurses’ commitment to positive perinatal outcomes. Mountain States Health Alliance. promoted early breastfeeding. enhanced quality of care. DE Keywords babies bonding breastfeeding PACU Newborn Care Poster Presentation Decline of the Gold Standard! Umbilical Cord Tissue Provides Timely and Accurate Results to Enhance Quality Outcomes for the Neonate Purpose for the Program ecent literature reviews stated that approximately 5% to 10% of women self-report the use of illicit drugs during pregnancy. Because of the sensitive nature of drug testing and possible legal ramiﬁcations. lactation consultants.
Making Kangaroo Care the Norm: Implementation of a New Model of Care Lynn Barabach. and ongoing care of the infant. or skin-toskin care. MSN. 41. Kangaroo care also is discussed during tours of the Birthing Center. Nursing leadership met with pathology and lab directors to discuss switching the testing location from a local laboratory to sending the tests to an outside reference lab. Purpose for the Program RN. A 4-hour program on Kangaroo care was developed and included discussion of the beneﬁts. It was identiﬁed that a key component for a successful journey was the implementation of Kangaroo care. The program accepts referrals from all the NICUs in the county and from the Health Department. USA designation. which was developed in collaboration between the departments of nursing and neonatology. this program will improve infant. Patient education included handouts on Kangaroo care for distribution during prenatal appointments.Bellamy. in the immediate postpartum period. obstetric. the Birthing Center began training the nurses on Kangaroo care and implementation soon followed. infant placement. the evaluation of parents and staff has been overwhelmingly positive and the funding has been extended for a second year. All nursing staff received in-service on neonatal abstinence scoring to help staff provide more consistent and accurate scores. Vol. Outcomes. RNC. Pediatric. Implications for Nursing Practice The use of high-ﬁdelity simulators may have a signiﬁcant role in the process of discharge teaching in the NICU. EdS. Initial implementation began at a regional tertiary care facility and a smaller community hospital where the largest volumes of maternal substance abuse were experienced. Lakewood. Lakewood Hospital. IBCLC. The program began accepting referrals in January 2011. and hospital readmission. The time in Kangaroo care with the mother would facilitate transition to extrauterine life and allow the infant to self-latch at the breast. prepared childbirth classes. Lakewood Hospital. T. and Evaluation Nursing leadership worked with a nationally recognized expert on Kangaroo care to provide education to the nurses. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention was seen as a necessary piece of our process improvement. and overall family well being. Implementation. emergency resources visits. Outcomes. OH Kate Salmon. The program also has the potential to decrease the use of health care resources. At Home with Your Baby Deborah Raines. The outcomes focused on increasing result turnaround times. The electronic health record was modiﬁed to include documentation of time in and out of Kangaroo care and with whom the infant was in Kangaroo care. and Evaluation The program is conducted in the department for caregiver education and uses a preemie high-ﬁdelity simulator. midwifery. CNM. and decreasing rates of false positive test results. and Evaluation The plan was discussed and approved by the neonatologists and pediatricians. Implementation. Data are being collected on the speciﬁc outcomes of parent conﬁdence and competence as caregivers as well as on unscheduled use of health care resources on infants. the Lakewood Hospital Birthing CenOH Joy Sedlock. PhD. Newborn Care Poster Presentation Proposed Change By enhancing parent conﬁdence and competence. Lakewood. The speciﬁc activities are adapted to the anticipated discharge needs of the infant. n 2009. Lakewood. and anesthesia providers were educated about Kangaroo care and the Birthing JOGNN 2012. Implications for Nursing Practice The implications for the nursing practice included the need for a standardized order set for newborns experiencing neonatal abstinence symptoms. potentially decreasing the newborn’s length of stay. Purpose for the Program Lakewood Hospital. Outcomes. To date. Placing the infant in Kangaroo care was demonstrated to validate understanding. Walden University. his community-based program is designed Boca Raton. RNC. MSN. MSN. Supplement 1 S53 . IBCLC. and breastfeeding classes. Implementation. such as 911 calls. In the fall of 2009. Newborn Care Poster Presentation Proposed Change Our goal was that all appropriate infants would be placed in Kangaroo care shortly after birth and would remain with their mother or the mother’s support person for 60 to 90 minutes. including assessment. ANEF. OH Keywords kangaroo care infant childbirth breastfeeding I ter embarked on the journey to obtain BabyFriendly. parent. FL Keywords NICU discharge simulation caregiver competence T to enhance parents’ competence and conﬁdence as caregivers after their infants’ discharge from the neonatal intensive care unit (NICU).
Infants also are placed in Kangaroo care shortly after a cesarean birth while the mother remains in the operating room. Discharge Planning in the Neonatal Intensive Care Unit Purpose for the Program o improve parents’ ability to care for their infants at discharge. Implications for Nursing Practice Discharge planning should begin on admission. Long-term infants get a journal with weekly pictures. Outcomes. We must change our culture of isolation to one of inclusion.01360.x http://jognn. and parental education. Memorial Hospital Miramar. The current practice in the Providence Alaska Medical Center Maternity Center is to perform sponge bathing under a radiant warmer on newborns within 2 hours of birth in the absence of birth stress Rebecca Heimann. MSN.org . and Evaluation The clinical manager recruited two staff nurses. It is not only a teaching process but should involve the parents in every aspect of their infants’ care. NNP-BC. RN. especially in conjunction with breastfeeding. Discharge map created: Outline discharge teaching with daily accountability for updates. Families have reported increased satisfaction with their birthing experiences. 41. Loughren. the more prepared they are to care for their infant at home.1552-6909. Between 90% and 98% of appropriate infants are placed in Kangaroo care. Registered nurses will be held accountable for daily teaching and documentation. a literature review. T Proposed Change To implement the following improvements in the neonatal intensive care unit (NICU): r r r r Cultural: More parental involvement. lactation consultants report a decrease in the incidence of delayed latch and breastfeeding problems. This nursing intervention quickly became a model of care for the Birthing Center. Nurses must be held accountable for discharge teaching on a daily basis. and family. it is beneﬁcial to the infant. Parents would hold infants every day. Our parent surveys improved from the 30th percentile for discharge planning to the 99th percentile. parents being unprepared to take their infants home. 2012.awhonn. Kathy J. Discharge mapping is an excellent tool to ensure that parents have covered all discharge information. AK Melissa Heath. nursing leadership worked on the issues to minimize interruptions of Kangaroo care. Anecdotally. Miramar.2012. DOI: 10. The percentage of appropriate infants in Kangaroo care following birth is reviewed monthly. Implications for Nursing Practice Kangaroo care assists the infant with transition and facilitates initial breastfeeding. FL Keywords neonatal intensive care unit (NICU) Newborn Care Poster Presentation Implementation. Teaching: A parent admission and discharge tool was created. Parents get a picture on admission. Anchorage. breastfeeding. Our evaluations have been overwhelmingly positive. included the following: an emotional approach. A research review revealed evidence supporting the theory that immersion T bathing improved temperature stability. As barriers were identiﬁed. and teaching. Providence Alaska Medical Center. and the associated risks were reviewed. and it is utilized throughout the hospital stay and families are encouraged to continue Kangaroo care at home. We offer all parents rooming in. Videos will be added to our television system for parental viewing.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Center’s change in the model of care immediately following birth. Anchorage. bonding. Parents should be actively involved and accountable for knowledge acquisition. mother. Parental Accountability: Parents will be actively involved in teaching and take responsibility for learning. holding. AK S54 JOGNN. Providence Alaska Medical Center. including rooming in.1111/j. Issues with discharge planning. Parents state that they feel at home within the NICU and are prepared to care for their infants. S1-S118. The more involved the family is. and a discussion of unit expectations. The use of Kangaroo care is truly a nursing intervention. RN. along with the American Academy of Pediatrics’ guidelines for discharge planning. The classes were mandatory for NICU nurses and Nurses’ Commitment to Best Practice Infant Care and Family Bonding Founded on Evidence-Based Research: A Journey of Infant Bathing Purpose for the Program he Professional Practice Committee hypothesized that we could improve postpartum wellborn baby care by switching from sponge bathing to immersion bathing.
and guarantee an appointment well within the state recommended 4-week timeframe. Stable temperature deﬁned as 97. The goals for this project are consistent immersion bathing per guidelines. ensure a reminder call is made. temperature regulation. Implications for Nursing Practice It is important for families to have their outpatient follow-up appointments within the same health system for convenience. increased patient satisfaction.Heimann. Outpatient Newborn Hearing Screening Program Nicole Giangregorio. respiratory distress.7◦ F to 99. Implementation. decrease the time between the initial hearing screening and the follow-up hearing screening. BS. Sharp Mary Birch he Newborn Hearing Screening Program is a Hospital for Women & California state mandated program requiring Newborns. The outpatient revenues previously went to other hospitals within the community. we have seen 382 outpatients with a steady increase each ﬁscal year. These tools will be presented to the staff at regularly scheduled staff meetings. and increased revenue. including increased oxygen consumption. The region reported a no-show rate of 12. as well as improved neonatal outcomes from decreased cold stress and calmer stabilization. improved breastfeeding. Tub bathing appears to be more effective than sponge bathing at maintaining body temperature and preventing temperature loss. 41.3% for July 2011 and Sharp Mary Birch Hospital for Women & Newborns reported a 0% no-show rate (the overall program no show rate is currently being calculated by the Regional Hearing Coordinating Center).5◦ F for 2 to 4 hours. the family is received and escorted to the outpatient clinic by a hearing screening technician. increased parental involvement and education covering proper positioning. Nurses also reported that breastfeeding and skin-to-skin bonding time often was interrupted to complete baths in the allotted 2-hour recovery time. extended skin-to-skin contact in the postpartum period. studies showed there is no difference in umbilical cord infection and healing rates and infants appeared more relaxed and less agitated during tub baths. exhaustion. CA T Keywords outpatient community hospital growth all infants to have a hearing screening prior to discharge. Proposed Change The Professional Practice Committee proposed a policy and procedural change to immersion bathing founded on evidence-based research. and care competency. Implications for Nursing Practice Increased parental involvement in newborn care results in greater uninterrupted bonding time. Currently. Also. Purpose for the Program LCCE. Outcomes. R. Since the outpatient program began in October 2008. Compared to our region. and Evaluation The outpatient program allows our hospital to schedule the follow-up appointment for all wellbabies prior to discharge. San Diego. policy. Vol. our patients are more satisﬁed. Outcomes. As a result. Implementation. the Professional Practice Council is developing a training video. Each outpatient appointment receives a reminder phone call 48 hours prior to their appointment. and signs and symptoms of infant distress. On the day of their appointment. Newborn Care Poster Presentation Proposed Change To increase the number of patients receiving outpatient hearing rescreenings. increased infant relaxation. M. The outpatient program is open to the community at-large allowing for quicker access to a follow-up hearing screening. our outpatient no-show rate is considerably lower. and Heath. and Evaluation The Professional Practice Council presented their research and ﬁndings to the Nursery Committee and received permission to proceed with a practice change. and Sharp Mary Birch Hospital for Women & Newborns now receives revenues from the insurance companies and the state for MediCal and/or uninsured patients. Hands-on training of nurses and techs will be conducted to assure comfort and competency in practice. complete all necessary paperwork. Supplement 1 S55 . and environmental or social distractions during the immediate postpartum period. CLE. and increase revenue. and hypoglycemia. Newborn Care Poster Presentation r r r Delay infant baths 2 to 4 hours to establish thermoregulation and decrease negative side effects of hypothermia. JOGNN 2012. which incorporated these key principles: r Infants at risk of transmission of hepatitis B and human immunodeﬁciency virus from maternal sources will be bathed within 2 hours of birth. Sharp Mary Birch Hospital for Women & Newborns additionally offers an outpatient hearing program for our well-baby population leading to increased patient satisfaction and delayed appointment times. Parental involvement is minimal because of decreased mobility from anesthesia. New parents are relieved to come back to the hospital where they gave birth versus going to a different clinic and navigating a new health system. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Keywords bathing education thermoregulation infant stability newborn care or trauma.
committed breastfeeding. particularly concerning milk supply. Our facility maintains a free. Newark. Outpatient clinicians can offer anticipatory guidance based on consistent patterns of data across the postpartum period.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention An Innovative Program to Support and Promote Breastfeeding: What Have You Done for Me Lately? Purpose for the Program espite evidence for breastfeeding beneﬁts. Inpatient nurses should address predictable areas of concern with new mothers.org . To ensure that Newborn Care Poster Presentation S56 JOGNN. Newark.025 mothers who breastfed and called during 2009 were examined. maintain momentum during the inpatient phase. 41.S. Christiana Care Health System. S1-S118. and weaning among other issues.awhonn. As part of this program. Outcomes. logs document telephone conversations. DE Keywords comprehensive breastfeeding program Christiana Care Health System (CCHS) Proposed Change To create a comprehensive breastfeeding program to meet the challenges stated above Implementation. RN. and 34. and pumping. This program promotes the development of knowledgeable mothers and health care providers. D mothers are being offered relevant information. Mothers may initiate a call at any time during their breastfeeding experience when they encounter questions or concerns. baby behaviors. breastfeeding hotline that is staffed by lactation consultants.1% breastfeed at 1 year. Implications for Nursing Practice A team approach focused on breastfeeding to support maternal-child nurses and mothers is one way to improve hospital practices and meet goals. as deﬁned in a separate performance improvement project. Recent Centers for Disease Control and Prevention data suggest less than 4% of U.9% of mothers initiate breastfeeding. The Surgeon General’s Call to Action to Support Breastfeeding underscores this critical need. and provide anticipatory postdischarge guidance so that a successful support program would be in place to meet the aforementioned goals. Data from 1. logs were subjected to qualitative analysis. MSN. EdD. hospitals fall short in breastfeeding rates and duration. NNP-BC.1111/j. predictable breastfeeding topics developed at key points during the ﬁrst year of life. Christiana Care Health System.1552-6909. Information and available resources that are appropriately timed and offered when the mother is ready to learn improve the chances that the mother will be able to process and retain the shared information. such as drug and diet interaction with milk. noting low priorities for breastfeeding. stooling patterns. and Evaluation Christiana Care Health System has built an enduring lactation program available across the continuum of perinatal care aimed to meet these action calls. Lynn E.x http://jognn. IBCLC.6% breastfeed at 6 months. and use of nonevidence-based practices as barriers to enduring breastfeeding.01360. and nearly 75% do not provide maternal support after discharge. Bayne. Support is offered to mothers and other perinatal clinicians by experienced lactation consultants to overcome breastfeeding obstacles. DE Elizabeth Chance. Christiana Care Health System. PhD. RN. DE Lydia Henry. Results of both projects clearly indicated the need to initiate breastfeeding education activities during prenatal classes. hospitals offer the full support necessary to meet enduring. 60. Ten themes emerged and speciﬁc. Newark. CCE. This challenges an institutional ability to meet the Healthy People 2020 goals to have 81.2012. Findings were then compared to the nurses’ perceived breastfeeding barriers by care area. DOI: 10. RNC-OB. 2012. which determined the nature of maternal concerns.
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