Klein, L.
I N N O VAT I V E P R O G R A M S
Newborn
Care
Lisa Klein, MSN, RNC-OB,
RNC-LRN, CNS, Marymount
University, Reston, VA
Keywords
neonatal
nursing
peripheral intravenous
assessment
documentation
Paper Presentation
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
JOGNN 2012; Vol. 41, Supplement 1
A Pilot Project to Improve Neonatal Peripheral Intravenous
Site Assessment and Documentation
Purpose for the Program
here is currently no consistent protocol de-
T scribed in the literature for documentation of
the nursing assessment of neonatal peripheral in-
travenous sites. Most authors concur that hourly
assessments are the minimum frequency and in-
dicate what the assessment parameters should
be; however, they do not discuss a protocol for
documentation of the assessments. Multiple au-
thors and professional nursing groups have iden-
tified that problems exist in the care of periph-
eral intravenous sites in neonates. This project
attempted to determine if nurses in a neonatal in-
tensive care unit (NICU) could conduct and docu-
ment an hourly evidence-based focused assess-
ment of neonatal peripheral intravenous sites.
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 interven-
tions 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 collec-
tion 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 excep-
tion for assessment of peripheral intravenous sites
The Great Pretenders: Utilizing Evidence-Based Practice
to Optimize Clinical Outcomes for the Late Preterm Infant
Purpose for the Program
he late preterm infant faces many challenges
T associated with prematurity. In 2010, 99 late
preterm infants (approximately 5% of the total birth
volume) were born at Peninsula Regional Medi-
cal Center. Nearly 29% of these infants were ad-
mitted 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 adopt-
ing 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
Proceedings of the 2012 AWHONN Convention
in neonates. This project introduced a documen-
tation 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 periph-
eral 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 instru-
ment 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 ex-
travasations, which would be useful in improving
patient outcomes.
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 pe-
riod to determine baseline rates of hypothermia,
S31
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 dif-
ficulties, phototherapy, excessive weight loss,
neonatal intensive care unit admissions, and read-
missions to the pediatric unit. A multidisciplinary
team developed the late preterm infant initiative
utilizing AWHONN’s clinical guidelines. Compo-
nents of the initiative included policy and order
set development, predelivery and predischarge
education, and individualized feeding plans. Be-
ginning 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 in-
fant. 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 inten-
sive care unit (25.8%), and no infants were read-
mitted to the pediatric unit. The overall goal is to
improve clinical outcomes while reducing admis-
sions to the neonatal intensive care unit by 10%
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
N is a widespread challenge. Most often in-
fants who are breastfed and are temporarily sep-
arated from their mothers receive formula as a
quick fix to increase blood glucose levels. This
approach not only decreases breastfeeding suc-
cess, but it also exposes the newborn to unsta-
ble 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 wit-
nessing 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.
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 keep-
ing them in continuous skin-to-skin contact. I had
recently become an international board certified
lactation consultant, and that new level of knowl-
S32 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
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 ex-
tremely 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, trans-
lates 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. Provid-
ing care that enhances family bonding, empow-
ers parents, and improves clinical outcomes in-
creases 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 pos-
sible sequelae related to late prematurity.
edge, coupled with my nursing experience, pre- Pamela Kinney Tozier, BSN,
pared me well for presenting my ideas to the RNC, CCE, IBCLC, Maine
administration. I also proposed that we estab-
lish ways to give colostrum to babies who were
Medical Center, Portland, ME
Keywords
not ready to latch effectively. I wanted to rewrite hypoglycemia
the existing breastfeeding policy, have nurses diabetics
adhere more vigilantly to our skin-to-skin policy, hand expression
colostrums
write a policy on prebirth hand expression of
skin-to-skin
colostrum, and be a driving force to change many
of the parameters of the newborn hypoglycemia
algorithm.
Newborn Care
Paper Presentation
Implementation, Outcomes, and Evaluation
We have successfully implemented a new hypo-
glycemia algorithm that accepts lower glucose
values initially, has the newborn feed first, and
then the first glucose level checked by 90 min-
utes 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 continu-
ous 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.
http://jognn.awhonn.org
Lawson, T.
Terry Lawson, RN, IBCLC,
University of California San
Diego Medical Center, San
Diego, CA
Keywords
human milk
premature infant nutrition
lactation consultant
Newborn Care
Paper Presentation
Katherine Y. Lucas, DNP,
APRN, NNP-BC, Cape Fear
Valley Health System,
Fayetteville, NC
JOGNN 2012; Vol. 41, Supplement 1
I N N O VAT I V E P R O G R A M S
Implications for Nursing Practice
Labor and delivery nurses are the first line of de-
fense in helping stabilize newborn glucose lev-
Premature Infant Nutrition Clinic
Purpose for the Program
he benefits of human breast milk for term in-
T fants outweigh formula. Breast milk is an even
greater benefit to the preterm infant because it
provides infection prevention and promotes im-
proved neurodevelopment. In 2006, the University
of California San Diego Medical Center was desig-
nated as Baby Friendly. The Supporting Premature
Infant Nutrition program was launched in 2007.
The goal was to improve the growth and nutrition of
preterm infants. It was noted that following hospi-
tal discharge, most mothers were not successfully
breastfeeding their premature infants. These in-
fants continued to require fortifiers, but we did not
know how much or for how long. Mothers contin-
ued to need to pump, but supply was decreasing.
Both parents were exhausted and overwhelmed.
Proposed Change
In August 2008, the Premature Infant Nutrition
Clinic was established by a pediatrician and reg-
istered nurse. Utilizing a team approach, visits in-
cluded infant’s growth and development assess-
ments and discussions of the mother’s concerns.
After the assessment and discussion, the regis-
tered nurse performs a lactation consult and as-
sesses the infant feeding, looking for ways to im-
prove milk transfer, increase milk supply, and in-
crease breastfeeding and decrease breast pump-
ing. At the end of the 45- to 60-minute session, a
plan is developed to help the mother reach the de-
sired goal. Visits are individualized, ranging from
Implementing Practice Protocols and Education to Improve
the Care of Infants with Neonatal Abstinence Syndrome
Purpose of the Program
he National Council on Alcoholism and Drug
T Dependency estimates that between 1% and
11% of babies born each year are exposed to il-
licit substances in utero. The American Academy
of Pediatrics reported that 50% to 95% of infants
exposed to opioids or opioid derivatives, including
heroin and methadone, develop neonatal absti-
nence syndrome (NAS). Research that is more re-
cent describes an increasing incidence of infants
Proceedings of the 2012 AWHONN Convention
els without the introduction of formula, thereby up-
holding the standard of best practice. It is possible
for just one nurse with a vision to apply evidence-
based practice to achieve quality outcomes.
one-time only to several visits 1 to 3 weeks apart. A
follow-up letter is sent to the primary provider with
appointment highlights and recommendations.
Implementation, Outcomes, and Evaluation
It was noted during the first year, 97 patients/183
visits occurred; the second year, 83 new patients;
and the third year, 130 new patients/637 visits oc-
curred. During the 3 years, the gestational age
breakdown included the following: 46 newborns
less than 30 weeks of gestation, 90 newborns 30
to 33 6/7 weeks of gestation, 104 newborns 34
to 33 6/7 weeks of gestation, and 40 newborns
greater than 37 weeks of gestation. Multiples data
included 215 singletons, 83 sets of twins, and 12
sets of triplets. Currently, the team sees 7 to 8 pa-
tients in a 4-hour session, 1 day a week. There is a
need to expand to 2 days to manage the increase
in consultations. Outcomes have improved, such
as increased breast milk for longer duration of
time, more breastfeeding, decreased/no breast
pumping, and increased exclusive breastfeeding.
Implications for Nursing Practice
Assuring best practice and performing research
is exemplified by the projects in progress, includ-
ing a Premature Infant Nutrition Clinic Quality As-
surance project, research of liquid fortification of
the mother’s milk at discharge, and an interna-
tional multicenter validation of a preterm growth
chart. Both providers and nurses are involved in
every aspect leading to increased patient and staff
satisfaction.
exposed to harmful substances prior to birth. Ba-
bies exposed to opioids or opioid derivatives dur-
ing pregnancy are at increased risk of developing
NAS. Optimal treatment of this NAS population is
hampered by the current lack of evidence-based
standardized guidelines and protocols for phar-
macologic management and care that promote
improved outcomes for NAS patients. Care and
management of these infants can be improved
with practice guidelines and education.
S33
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 clin-
ical practice guidelines and an educational pro-
gram on NAS and the Finnegan Neonatal Absti-
nence Scoring Tool (FNAST), to improve nursing
assessment and care of the NAS infant, and im-
prove scoring accuracy with use of the FNAST.
Implementation, Outcomes, and Evaluation
This study was a nonexperimental, pretest/
posttest study that evaluated change in nursing
knowledge about NAS and use of the FNAST after
the implementation of a quality improvement, ed-
ucational project. Nurses were tested before and
after participation in education about NAS. A sub-
set of 10 nurses was evaluated using the FNAST
with video of infants having NAS. Volunteer par-
ticipation in the NAS educational project occurred
in 81% of the neonatal intensive care unit nurses.
All nurses showed some improvement in scores
Perinatal Palliative Care: Support of Mothers,
Infants and Families
Purpose for the Program
o support mothers, infants, and families
T through the Perinatal Palliative Care program.
Proposed Change
To enhance the existing bereavement program
to include infants with low viability or no viability
through palliative care.
Implementation, Outcomes, and Evaluation
Implementation is in process and awaiting final
approval of pertinent policies and procedures to
Neonatal Head Trauma: Implementation of a Care Algorithm
to Improve Safety
Purpose for the Program
o create a process by which newborns with
T head trauma or at risk of complications of
neonatal head trauma are identified, assessed,
and monitored differently with the goal of improv-
ing safety.
S34 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
on the posttest, with 2% to 44% improvement. All Keywords
10 nurses who participated in the interactive video NICU
test scored 90% or higher against the FNAST cri- FNAST
education
terion 1 week after participation in the educational
project.
Implications for Nursing Practice Newborn Care
Evidenced-based clinical practice guidelines and Paper Presentation
education on NAS and the FNAST equip care-
givers with the necessary tools to consistently and
accurately assess an infant with NAS when using
the FNAST. Recent research shows that provid-
ing education to nurses can result in knowledge
gained, improved professional practice, and im-
proved patient treatment goals. Education also
can equip nurses with the necessary knowledge
to care for patients with complex medical prob-
lems like NAS. Further, providing nurses with
specific information about a medical problem
is correlated with improved adherence to best
practice.
support this program. The evaluation will be based J. Frances Fusco, MHS, BSN,
upon a patient satisfaction survey taken by tele- RN, University Community
phone follow-up of patients discharged from the
hospital.
Hospital, Tampa, FL
Theresa Bish, RN, IBCLC,
University Community
Implications for Nursing Practice Hospital, Tampa, FL
Provide care and support to both infants and moth-
Keywords
ers going through this experience. perinatal palliative care
infant advanced directives
Newborn Care
Poster Presentation
Proposed Change Sandra Hoffman, MS, RN,
To create and implement a neonatal head trauma CNS-BC, Abbott Northwestern
algorithm that is part of the newborn standing or- Hospital, Minneapolis, MN
ders across a large multihospital health system
to ensure that newborns who are at risk of head
trauma or who have head trauma, are evaluated
more closely to ensure their safety.
http://jognn.awhonn.org
Braithwaite, P., Donahue, N. and Bayne, L. E. 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, Outcomes, and Evaluation
Neonatal head trauma can result in catastrophic
outcomes, and it is essential that infants at risk
of complications of a difficult or instrumented de-
livery are identified and monitored more closely.
Complications, such as subgaleal hemorrhages
may manifest at birth or may occur over many
hours, so identification of infants at risk and in-
creased vigilance is important for patient safety.
After a review of the literature, a multidisciplinary
team of neonatal and birthing clinical nurse spe-
cialists, pediatricians, a neonatologist, and a
neonatal nurse practitioner created a neonatal
head trauma algorithm to become part of the new-
born standing orders. Staff and physician educa-
tion was done regarding neonatal head trauma,
and the neonatal head trauma algorithm was im-
plemented across a large multihospital health sys-
tem. The evaluation of this change is ongoing.
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. A stan-
dardized approach can ensure the identification
and closer monitoring of infants who may have an
injury that may not manifest for many hours after
delivery. Education about neonatal head trauma
increases awareness of the risks, promotes ap-
propriate pain management, and helps to keep
newborns safe.

Help! I’m Cold! Improving the Warmth of Our Newborns

Pamela Braithwaite, BSN, Purpose for the Program
RNC, Christiana Care Health ozy Cuties is a multidisciplinary performance
System, Bear, DE
Nicole Donahue, BSN, MSN,
Cimprovement team convened to address hy-
pothermia from birth to admission to the neona-
RNC, Christiana Care, tal intensive care unit among inborn preterm in-
Middletown, DE fants at less than 31 weeks gestational age. Re-
Lynn E. Bayne, PhD, NNP-BC, view of facility data over the past 5 years showed
RN, Christiana Care Health that the initial admission temperatures of these
System, Newark, DE infants were significantly lower than average in
our neonatal intensive care unit (NICU) than the
Keywords
preterm benchmark of 850 NICUs within the Vermont Ox-
hypothermia ford Network. Across this time period, 61% of the
fishbone diagram infants who were less than 31 weeks gestational
root-cause analysis age had body temperatures less than 36◦ C at ad-
morbidity mission and were classified as hypothermic using
mortality
the World Health Organization definition. Two large
polyethylene
studies of infants from 23 weeks to 30 completed
weeks of gestation, suggested that when infants
are admitted to the NICU with hypothermia, their
Newborn Care chances of survival decrease by approximately
Poster Presentation 10% for every degree below 36◦ C, independent
of any disease conditions. In addition, late onset
sepsis is increased by 11% and odds of death are
increased by 28%.
mal intervention bundle was developed and im-
plemented. The bundle included a timeout-style
thermal checklist, increased room temperature,
proper radiant warmer preheat and use, short-
ened infant time at point of delivery for both vagi-
nal birth and cesarean birth, change in transfer
technique of newborn to a warmer from point of
delivery, effective use of polyethylene wrap, at-
tention to application of pulse oximetry, warming
of surfactant, and warming of caregiver hands.
Aggressive clinical staff education in labor and
delivery and NICU was conducted using a vari-
ety of methods, including video and social media.
Post-implementation, infants who were less than
31 weeks gestational age were prospectively fol-
lowed and the incidence of the outcome variables
was collected.
Implementation, Outcomes, and Evaluation
Data were analyzed, 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. Ongoing monitoring
for sustained improvement is now in place.

Proposed Change Implications for Nursing Practice

Root cause analysis using fish bone techniques
was conducted on the first five cases of ad-
mission of hypothermia for each calendar month
over the 12-month period prior to project incep-
tion. Literature was reviewed to establish potential
causes. A facility tour determined how many po-
tential causes existed and coupled the potential
cause with evidence-based interventions. A ther-
A multidisciplinary team can be an extremely ef-
fective agent of change. It is important to bring
key stakeholders in a project to realize gains. Clin-
icians are obligated to benchmark practices that
may contribute silently to patient illness. Body tem-
perature should never be taken for granted. The
goal should always be to keep a warm infant warm,
not to rewarm a cold infant.

JOGNN 2012; Vol. 41, Supplement 1 S35

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 dis-
I charge process and complex follow-up care for
the very premature or sick infant. Involve parents
in the plan of care, the daily care of their infants,
and their personal preferences early on.
Proposed Change
To standardize teaching, timing of education, doc-
umentation, and communication of education to
better prepare parents for discharge.
Birthways Lactation Services: A Model
for Breastfeeding Support
Purpose for the Program
he purpose of the Birthways Lactation Ser-
T vices program is twofold. We want to increase
breastfeeding initiation and duration rates and
thereby improve long-term health for every infant.
We also want to increase the lactation consultant’s
productivity while decreasing full time equivalents
and cost. Most lactation programs have lost state
funding in recent years and are now funded by
hard-to-find grants, or as in our hospital’s case, by
community benefit dollars.
Proposed Change
For 10 years, 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. Eight years ago, it was deter-
mined this was a costly way to deliver care even
with funds provided by a grant and some insur-
ance reimbursement. At that time we started the
clinic model and were encouraged by the pos-
itive results. Our lactation consultants cross-train
to the discharge planning position of the Birthways
Lactation Services program where they round with
the pediatricians, schedule the clinic visits at dis-
charge, and provide a discharge feeding plan for
babies with feeding problems.
Implementation, Outcomes, and Evaluation
Three to five times per day, the coordinator of the
lactation program and her team perform checks
S36 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
Implementation, Outcomes, and Evaluation Geraldine Tamborelli, MS, RN,
Implementation using Plan-Do-Study-Act cycles, Maine Medical Center,
staff and patient satisfaction, as well as chart au-
dits were used for measurement and feedback.
Portland, ME
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.
multidisciplinary
Newborn Care
Poster Presentation
that include weight, jaundice, and lactation evalu- Angela Carswell, RN, IBCLC,
ation. We believe our outcomes reflect the success Mary Greeley Medical Center,
of the program. Our breastfeeding initiation rate is
87.6% as compared with the state’s 73.9%. Our
Ames, IA
Keywords
6-month breastfeeding rate is 79.3% (one of the lactation program
best in the state) as compared with the national exceeding national and state
rate of 17%. We are ahead of the Healthy People breastfeeding rates
2020 goals of an 81.9% initiation of breastfeeding
and a 6-month breastfeeding duration of 60.6%.
Our home visit model took 3.1 full time equivalents, Newborn Care
and our clinic model takes 1.2 full time equivalents, Poster Presentation
which represents a savings of more than $140,000
in salaries and mileage reimbursement. Our lacta-
tion consultants can see five more infants per day
or 25 more per week, which makes it possible to
provide second visits for those clients who need
them.
Implications for Nursing Practice
The advantages of breastfeeding are well re-
searched and well documented. 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 State-
ment and the U.S. Surgeon General’s Call to Action
to Support Breastfeeding. Our service model de-
creases hospital readmission rates and promotes
exclusive breastfeeding with increased productiv-
ity and decreased cost.
http://jognn.awhonn.org
Keller, A. and Brenneman, 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

Anne Keller, MS, RNC, CNP, Purpose for the Program
OhioHealth, Columbus, OH angaroo care is recommended in the Guide-
Alicia Brenneman, BSN, RNC,
Grant Medical Center
K lines for Perinatal Care for stable newborns.
The act of placing the infant skin-to-skin (also
OhioHealth, Columbus, OH called Kangaroo care) with the mother has been
shown to maintain skin temperature regulation
Keywords
of the newborn, increase initiation of successful
Kangaroo Care
cesarean birth breastfeeding, and ease the transition for intrauter-
ine to extrauterine life. The practice of Kangaroo
care has been well adopted in our setting. During
2010, 75% of all mothers who gave birth vaginally
Newborn Care
participated in skin-to-skin care. The staff started
Poster Presentation to initiate Kangaroo care in the postanesthesia
care unit to provide all the benefits to the moth-
ers who had cesarean births.
Proposed Change
Before the initiation of skin-to-skin in the postanes-
thesia care unit, infants had been removed from
the warmer after being wrapped with warm blan-
kets and a hat and given to the mother to hold
or breastfeed. This process was not satisfying to
the staff. The staff stated that if the vaginal birth in-
fant could benefit from skin-to-skin, then we should
adopt the practice with the cesarean birth infant.
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.
Implementation, Outcomes, and Evaluation
The implementation was started by staff nurses
who considered the evidence-based practice of
Kangaroo care to be best for the newborn. Staff
began by placing the infant skin-to-skin after mov-
ing the mother from the operating room table
to a hospital bed. Both are transported to the
postanesthesia care unit, initial checks are pre-
formed, and a baseline set of vitals is obtained
on the infant. The mother-infant pair is left skin-
to-skin for the next 60 to 90 minutes. Outcomes
have been measured by patient satisfaction and
stable infant temperatures during the time frame.
Patients report they would initiate Kangaroo care
with their next birth.
Implications for Nursing Practice
Empowering nurses to change practice to over-
come traditional barriers of medical care to pro-
mote the empowerment of motherhood.

Infant Feeding Plan: An Innovative Documentation Tool to

Jennifer Peterman, RN, BSN,
IBCLC, Hospital of the
University of Pennsylvania,
Philadelphia, PA
Keywords
breastfeeding
infant feeding plan
patient–family centered care
Newborn Care
Poster Presentation
Improve Communication between Caregivers and Families
Purpose for the Program
lack of communication was identified sur-
A rounding a mother’s feeding decision and
multiple health care providers. This lack of com-
munication resulted in a mother’s perceived lack of
respect by providers regarding her preference for
newborn feeding. To address this issue, an innova-
tive, crib side, infant feeding plan documentation
tool was created to identify a mother’s preference
for feeding her newborn from birth through dis-
charge. Providers also noted a large variation be-
tween provider practices related to newborn feed-
ing and maternal preference.
Proposed Change
To improve communication between providers
and mothers, a crib side infant feeding plan doc-
umentation tool was implemented.
Implementation, Outcomes, and Evaluation
Prior to implementation, representatives from each
provider group involved in newborn care collab-
orated on the creation of the infant feeding plan
document. The development of the individualized
plan began at maternal admission, with the use of
a scripted narrative, to discuss maternal newborn
feeding preferences. Once feeding preferences
were identified, a mutually agreed upon feeding
plan was created and signed by both the mother
and the nurse. Throughout the infant’s stay, the
plan was located at the infant’s crib. If any changes
to the feeding plan were needed, both the nurse
and mother discussed, updated, and signed the
revised feeding plan.
Outcomes and evaluation are ongoing
Prior to the implementation of the feeding plan,
breastfeeding rates were 68% and during the year
postimplementation, breastfeeding rates have
continued to increase to 74%. Anecdotally, pa-
tients report feeling that their infant feeding
choices are respected and that the use of this plan
prompts infant feeding discussions. Providers
commented that the plan is convenient and useful
in practice, and the Joint Commission recognized
it as a best practice model of care.

JOGNN 2012; Vol. 41, Supplement 1 S37

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 com-
munication and infant feeding, especially breast-
feeding. Patient–family centered care is based
on respect and honest communication between
providers and families. This tool gave nurses an
opportunity to dialogue with the infants’ mothers
A Baby Weigh Station: Continuum of Care for Late Preterm
Breastfeeding Infants
Purpose for the Program
ate preterm infants who breastfeed are the
L largest segment of preterm infants. In Colum-
bus, Ohio, the incidence of late preterm infants
who breastfed was 9.1% of live births (in 2008)
and the rate at our hospital was 7.7% (of 6,456
births/year in 2010). Late preterm infants often ap-
pear to be able to breastfeed successfully during
hospitalization, (hence, their nickname “the great
imposter”), but this may not be sustained follow-
ing discharge. As 1 of 15 sites for the Associ-
ation of Women’s Health, Obstetric and Neona-
tal Nurses’ 2010 Late Preterm Infant Evidence-
Based Practice Guidelines research study, com-
mitment occurred in this hospital’s outpatient set-
ting to measure and improve post-discharge care
of late preterm infants who breastfed.
Proposed Change
To ensure a successful continuum of care for the
postdischarge late preterm infant via a commu-
nity resource where 90% of late preterm infants
will gain weight after events of lactation consulta-
tion and first weight measurement.
Implementation, Outcomes, and Evaluation
Utilize a baby weigh station within a user-friendly
lactation support center to offer a community ac-
cessible onsite, free service, monitored by ap-
S38 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
regarding feeding options and changes in infant
feeding as needed. At admission, nurses were
able to review with the family the evidence asso-
ciated with optimal infant feeding. Also, the tool
served as a contract between the mother and
the providers to ensure that the mother’s feeding
preference plan was implemented. The tool also
served as an easy way to communicate to any
provider caring for the infant.
proachable staff and expert professionals. Identify Kathleen H. Bright, BSN,
late preterm infants who return for repeat weight RNC, IBCLC, Doctors
measurement, track weight gain, and generate
monthly progress reports. To estimate the total
Hospital-Ohiohealth,
Columbus, OH
number of late preterm infants who were consulted Joyce Sheppard, RN, IBCLC,
and weighed on more than one visit, the following Women’s Health Services,
formula was used: Numerator – number of late Riverside Methodist Hospital,
Columbus, OH
preterm infants who gain weight of more than 0.5
ounces at more than 5 days of age and thereafter; Whitney Lenger Mirvis, BSN,
Denominator – total number of late preterm infants RN, IBCLC, Riverside
consulted/weighed. Over 12 months, 151 individ- Methodist Hospital, Columbus,
OH
ual late preterm infant weights were measured:
116 had repeated weights and 99% demonstrated Jane Lamp, MS, RN-BC, CNS,
weight gain (monthly averages). Additional bene- Riverside Methodist Hospital,
fits included referrals to lactation, pediatrics, pe- Columbus, OH
diatric surgery, and behavioral services. An ac- Keywords
cessible weigh station was evaluated to be an ef- late
fective pathway to ongoing care and support for preterm
late preterm infants. Late preterm infants gained breastfeeding
weigh
weight appropriately and their mothers reported
sustained breastfeeding.
Newborn Care
Implications for Nursing Practice Poster Presentation
Accessible community service, monitored by ap-
proachable staff and expert professionals is an
effective means to continue and grow client re-
lationships. Monitor at-risk groups for anticipated
problems and provide a portal for continuing care.
http://jognn.awhonn.org
Dohnalek, L., Heer, C., Starrels, E., Ryan, C. A., Howland, M. and Wurster, L. O.
Laurie Dohnalek, RN, MBA, Purpose for the Program
NE-BC, Georgetown University
Hospital, Washington, DC
Cynthia Heer, RNC-OB,
RN-BC, MSN, Georgetown
University Hospital,
Washington, DC
Elizabeth Starrels, RN, BSN,
IBCLC, Georgetown University
Hospital, Washington, DC Implementation, Outcomes, and Evaluation
Carol A. Ryan, MSN, RN,
IBCLC, FILCA, Georgetown
University Hospital,
Washington, DC
Margaret Howland, RN, BSN,
RNCOB, Georgetown
University Hospital,
Washington, DC, DC
Lauren O. Wurster, RN, MSN,
Georgetown University
Hospital, Washington, DC
Keywords
exclusive breastfeeding
exclusive breast milk feeding
breastfeeding rates
Joint Commission
perinatal core measure
Newborn Care
Poster Presentation
Julie Delcasino, RNC-MNN,
BSN, Presbyterian Healthcare,
Charlotte, NC
Diane Slough, RN, BSN,
IBCLC, Presbyterian Hospital,
Charlotte, NC
Keywords
exclusive breastfeeding
Newborn Care
Poster Presentation
JOGNN 2012; Vol. 41, Supplement 1
I N N O VAT I V E P R O G R A M S
Increasing Exclusive Breast Milk Feeding Rates at an Urban
Academic Hospital
o increase exclusive breast milk feeding rates
T at an urban academic hospital.
Proposed Change
Over an 18-month period interventions were imple-
mented to increase exclusive breast milk feeding
rates by at least 10%.
To implement this program, the following interven-
tions were completed:
r Creation and implementation of Donor Pas-
teurized Milk Policy; all nurses attended
mandatory education session
r Implementation of 24-hour rooming in (no
separation of mothers and newborns via stan-
dard nursery)
r Survey given to patients to identify the most
popular reasons for supplementation
r Journal clubs discussing breastfeeding is-
sues
r Consultations with lactation consultants at
other facilities
r Increasing rates and duration of initial skin-to-
skin contact and first breastfeeding session
r Daily patient rounds and assessments by in-
ternational board certified lactation consul-
tant
r Mandatory interdisciplinary breastfeeding
education for all nurses, obstetricians, and
pediatricians
r Education related to alternative breast milk
feeding methods
r Outside speaker (international board certi-
fied lactation consultant) that moderated dis-
Exclusive Breastfeeding: “It Takes Our Village”
Purpose for the Program
xclusive breastfeeding is best for the infant
E and mother. Evidence-based practice de-
scribes this choice, but who can say their hospital
truly promotes exclusive breastfeeding? We are a
600-bed hospital with more than 7,000 births/year.
It takes our village to educate the mother, fam-
ily, and staff within women’s services. It is the re-
sponsibility of us all to help mothers be successful
and promote the recommendations of the Asso-
ciation of Women’s Health, Obstetric and Neona-
tal Nurses, World Health Organization, American
Academy of Pediatrics, American College of Ob-
Proceedings of the 2012 AWHONN Convention
cussion of obstacles to exclusive breast milk
feeding
r Feeding care plans (for complicated situa-
tions) developed collaboratively with nurses
and international board certified lactation
consultants
r Implementation of mother and newborn
“quiet time”
These interventions were implemented and the re-
sult was an increase in the staff’s knowledge and
skills, thus changing practice and creating confi-
dence. The outcome was that our exclusive breast
milk feeding rates increased. A data collection tool
was created to monitor and track exclusive breast
milk feeding rates. We also are utilizing a patient-
based survey to evaluate the effectiveness of the
interventions.
Implications for Nursing Practice
Education is a major aspect of our initiative to in-
crease exclusive breast milk feeding rates. The
low incidence of exclusive breastfeeding is par-
tially due to a lack of breastfeeding knowledge
among health care professionals. Educational pro-
grams that increase nurses’ knowledge and im-
prove attitudes toward breastfeeding promote ac-
curate and reliable delivery of breastfeeding infor-
mation and skills to the mothers. These programs
also encourage positive role modeling of support-
ive breastfeeding attitudes. This may improve ex-
clusive breast milk feeding rates because of the
effect that this has on patients. Many of the in-
terventions included in our program are directly
aimed at increasing breastfeeding knowledge of
our staff and patients.
stetricians and Gynecologists, U.S. Department of
Health and Human Services, Centers for Disease
Control and Prevention, and the Joint Commission
for exclusive breastfeeding.
Proposed Change
We want to provide best patient care. In May
2010, our exclusive breastfeeding rate was 37%.
We realized our shortfall and discussed ways to
improve our rate. Within our shared governance
structure, we have a unit research council. The
topic of change regarding exclusive breastfeed-
ing, hospital supplementation, and education for
S39
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. Our council consists of
staff nurses from the departments of mother–baby
and gynecology. The nurse educator and lacta-
tion consultant are also committee members. We
began with a literature search. 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, “You need your sleep at night. A little for-
mula never hurt.” What about labor and delivery
nurses who say, “Breastfeeding is not our job, it’s
the lactation consultant’s job.” Extensive educa-
tion was needed for women’s services staff, physi-
cians, parents, and families.
Implementation, Outcomes and Evaluation
The nurse educator and lactation consultant de-
veloped an education program for all women’s
services staff. The major health care organizations
that recommended exclusive breastfeeding were
Now I Lay Me Back to Sleep . . . .Safely
Purpose for the Program
ne of the Healthy People 2020 goals is to im-
O prove the health and well being of women,
infants, children, and families. One way to accom-
plish this goal is by reducing the rate of fetal and
infant deaths. In Virginia, from 2003 to 2007, there
were approximately 78 infant deaths/year due to
sudden infant death syndrome (SIDS). This rate
is greater than the national average. It has been
proven that supine sleeping is the greatest fac-
tor in reducing the risk of SIDS even though many
nurses still feel more comfortable placing the baby
prone. Hospital nurses are the first professional
role models for new parents. Modeling suggested
behaviors, such as back sleeping, can be a pow-
erful education tool as well as parental education
through verbal and written educational materials.
Proposed Change
Infants are no longer able to have stuffed animals
or extra blankets in the incubator or crib. Once
the infant is transitioned to an open crib, the infant
should be placed in a supine position unless a
physician’s order indicates otherwise. Nurses are
to model safe sleep positioning at least 24 hours
prior to discharge and provide parental education
on SIDS and SIDS risk reduction. SIDS education
is also offered at infant cardiopulmonary resusci-
tation classes.
S40 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
cited. Articles from the literature search were pre-
sented. Benefits of breastfeeding for the mother,
infant, and community were discussed. Many ex-
amples of hospital practices that decrease suc-
cess of exclusive breastfeeding were recalled.
Skin-to-skin care and rooming in were discussed.
In North Carolina, we have the Perinatal Qual-
ity Collaborative of North Carolina for exclusive
breastfeeding. The Perinatal Quality Collaborative
of North Carolina’s well-baby track focuses on
supporting mothers’ choice to provide exclusive
breastfeeding for their term infants. We became
an active member of the Perinatal Quality Col-
laborative of North Carolina project for exclusive
breastfeeding.
Implications for Nursing Practice
We want to provide the best practice and the litera-
ture supports exclusive breastfeeding. As obstet-
ric nurses, we have power to educate and support
mothers and families to make informed decisions
about their individual infant’s care.
Implementation, Outcomes, and Evaluation Courtnie J. Burrell, RNC,
The safe sleep task force was initiated and a hos- Henrico Doctors’ Hospital,
pital policy on safe sleep was written. The staff
received mandatory in-services regarding SIDS to
Richmond, VA
Diane Stairs, RN, Henrico
ensure consistency in parental education. One in- Doctors’ Hospital, Richmond,
service was on SIDS and SIDS risks in the term VA
newborn and the other addressed the needs of the Keywords
premature infant. Safe sleep education was added SIDS
to the March of Dimes notebook, which all parents safe sleep
of infants admitted to the neonatal critical care model
center receive. This is reviewed with the parents
prior to discharge. An education record is signed
at discharge acknowledging that the information Newborn Care
was reviewed. After discharge the charts are Poster Presentation
retrospectively audited for safe sleep education
and supine positioning at least 24 hours prior to
discharge.
Implications for Nursing Practice
The expectation is to provide consistent safe sleep
education to the parents and to model safe sleep
positioning. Data collected will be used to validate
success of the program and to encourage the staff
continued participation and support. Integrating
evidence-based findings into practice will facili-
tate further involvement into addressing the higher
incidence of sudden infant death syndrome in the
African American population.
http://jognn.awhonn.org
Dohnalek, L., Heer, C., Starrels, E., Ryan, C. A., Howland, M. and Wurster, L. O.
Jennifer L. Reeg, MSN, RNC,
Health First Cape Canaveral
Hospital, Cocoa Beach, FL
Tracy Lott, RNC, BSN, MS,
Health First Cape Canaveral
Hospital, Cocoa Beach, FL
Keywords
breastfeeding
skin-to-skin care
kangaroo care
newborn
Newborn Care
Poster Presentation
Lindsay Newland, RN, BSN,
IBCLC, Baylor University
Medical Center Dallas, Dallas,
TX
Keywords
cue based feeding
infant driven feeds
NICU
feeding
Newborn Care
Poster Presentation
JOGNN 2012; Vol. 41, Supplement 1
I N N O VAT I V E P R O G R A M S
Implementing Skin-to-Skin Care in a Baby-Friendly
Community Hospital
Purpose for the Program
o improve mother–infant attachment and
T breastfeeding.
Proposed Change
To implement skin-to-skin care in a baby friendly
community hospital.
Implementation, Outcomes, and Evaluation
Health First, Inc. Cape Canaveral Hospital, a
Baby-Friendly facility since June 2000, launched a
skin-to-skin initiative in 2009. An evidence-based
practice protocol for placing newborns skin-to-
skin at birth and in the immediate postpartum pe-
riod was incorporated into our labor, delivery, re-
covery, and postpartum (LDRP) unit, and encour-
aged during the entirety of the postpartum stay.
Staff nurses were educated in appropriate skin-to-
skin techniques and patient instruction, first in a
small group interactive setting and later followed
with a video and discussion format. Patient ed-
ucation pamphlets were distributed to women in
labor and Kangaroo care shirts were loaned to
new mothers during their hospital stay. Families
were encouraged to attempt to keep their new-
born 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. Mothers were
assured that anyone, e.g., fathers and grandmoth-
ers, can engage in the skin-to-skin care with the
infant. Studies have reported benefits of skin-to-
skin care of the newborn to include reduced cry-
ing, improved mother–infant interaction, warmer
babies, and greater breastfeeding success. Ad-
Cue-Based Feeding: Implementation in an 83 Bed, Level
Three, Metropolitan Neonatal Intensive Care Unit
Purpose for the Program
he purpose of this program was to implement
T cue-based feeding in our neonatal intensive
care unit (NICU).
Proposed Change
Achievement of full oral feedings is often times
the last milestone reached prior to discharge
from the NICU. Many NICUs still used a sched-
uled feeding method to initiate and progress oral
feedings. Several studies have come out to sup-
port that a cue-based feeding approach, also
known as an infant-driven approach, may help
Proceedings of the 2012 AWHONN Convention
ditional positive effects on neonatal self-regulation
during the transition from intrauterine to extrauter-
ine life include increased sleep, decreased apnea
and bradycardia, improved respiration and oxy-
gen saturation, accelerated weight gain, and, for
the mother, increased milk production. The staff at
Cape Canaveral Hospital has observed anecdotal
evidence of these benefits.
The nursing and lactation staff at Cape Canaveral
Hospital strive to achieve skin-to-skin care with ev-
ery new mother–baby couplet, making allowance
for individual circumstances and infant condition.
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, and of documentation of mother
education on benefits of skin-to-skin care. Results
show a 90% success rate, indicative of a positive
trend in the number of mother–baby couplets opt-
ing for this practice and verbalizing their intent to
continue skin-to-skin care at home. Mothers seen
one-on-one in the lactation clinic after discharge
are further encouraged to continue skin-to-skin
care in the first weeks.
Implications for Nursing Practice
The practice of skin-to-skin care as a component
of our baby friendly philosophy contributes posi-
tively to neonatal transition, enhances attachment,
and promises long-term benefit to new families.
We at Cape Canaveral Hospital are committed to
continuing promotion of skin-to-skin care as part
of best practice.
the NICU infant achieve full oral feedings up to
6 days sooner than a scheduled feeding method.
A cue-based feeding approach tailors the pro-
gression of oral feedings for each individual, with
close attention paid to the infant’s developmental
cues to decrease stress. The following outlines our
transition from scheduled feedings to cue-based
feedings.
Implementation, Outcomes, and Evaluation
We introduced a cue-based feeding program in
our 83-bed, level three, metropolitan NICU, which
has more than 200 nurses and staff. This was
S41
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.
Staff education was given by nurses, including
one team leader and four super-trainers on each
shift. Education was given in the form of bedside
in-services, updates in the unit newsletter, a nurs-
ing policy and guideline, and a continuing educa-
tion offering. The education ranged in topics, such
as benefits of cue-based feeding, how to read in-
fant cues, how to use a cue-based feeding scale
form, educating parents, and trouble shooting. Af-
ter implementation, bedside charts were audited
to assess staff adherence with cue-based feed-
ing and address issues. Concerns and common
issues were addressed in the form of bedside
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
M noise affects neurodevelopment in infants.
Our clinical excellence committee wanted to ex-
plore the noise levels in our neonatal intensive
care unit (NICU). Our findings were that our levels
exceeded recommended levels. Based on these
findings, we felt that changes needed to be made.
Proposed Change
We provided education on the effects of excess
noise on neonates to our NICU staff and imple-
mented noise-reduction strategies in an attempt
to decrease our overall noise level.
Implementation, Outcomes, and Evaluation
Our clinical excellence committee presented edu-
cation on the effects of excess noise with the sup-
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
A States in response to the American Col-
lege of Obstetricians and Gynecologists’ state-
ment concerning vaginal birth after cesarean,
studies demonstrated higher dissatisfaction with
childbirth experiences. Women giving birth by ce-
sarean are more prone to postpartum depression,
bonding difficulties, and unsuccessful breastfeed-
ing.
Proposed Change
To increase maternal delivery satisfaction, we de-
veloped a plan to provide skin-to-skin contact
immediately after cesarean births. The proposed
change broke the barriers between the traditional
S42 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
in-services, questions and answers, updates in
emails and newsletters, as well as focus groups on
each shift. A multidisciplinary meeting took place 6
months after implementation to address concerns
and update the program.
Implications for Nursing Practice
Cue-based feeding has become a common lan-
guage in our unit and is considered a success.
Research is currently underway in our unit to as-
sess time to full oral feedings and the effect on
direct breastfeeding rates. Future research to con-
sider is the effect that cue-based feedings has on
oral aversion after discharge.
port of the hospital leadership. Education included Jennifer L. Notestine, BSN,
presentations in unit meetings as well as poster RNC-NIC, Mount Carmel East
presentations. Specific noise-reduction strategies
were proposed by the clinical excellence commit-
Hospital, Columbus, OH
Teresa L. Rapp, RN, NNP-BC,
tee and agreed upon by the staff. Strategies were Mount Carmel East Hospital,
implemented by the staff and follow-up monitoring Columbus, OH
was completed to assess effectiveness. Keywords
noise
neurodevelopment
Implications for Nursing Practice neonate
Research has shown that the immediate effects neonatal intensive care unit
of elevated levels of sound show that environ-
mental noise can be a major source of stressful
stimulation, can cause agitation, and bring about Newborn Care
complications in the medical management of the
neonate. Heightened awareness of the effects of
Poster Presentation
noise in the NICU promotes an optimal environ-
ment for positive developmental outcomes.
surgical environment and the delivery room and Nora C. Fortin, RNC-OB, BSN,
required collaboration between the departments Wentworth Douglass Hospital,
of surgical services, anesthesia, pediatrics, and
obstetrics.
Dover, NH
Keywords
skin-to-skin
Implementation, Outcomes, and Evaluation patient satisfaction
Informal surveys of patient satisfaction since im- neonatal thermoregulation
plementation have been positive. A more formal
evaluation of the process will include a review of
newborn thermoregulation in the operating room Newborn Care
and a postpartum survey of patient satisfaction. Poster Presentation
Implications for Nursing Practice
This new service is an example of how nurses are
empowered to question tradition to advocate for
their patients.
http://jognn.awhonn.org
Fortin, N. C. I N N O VAT I V E P R O G R A M S
Mom’s Own Milk Bundle: Increasing Supply in an 83 Bed,
Level III, Neonatal Intensive Care Unit
E. Christina Conner, BSN, RN, Purpose for the Program
IBCLC, Baylor University ospitals are encouraged to step up
Medical Center at Dallas,
Dallas, TX H evidence-based practices with various ini-
tiatives, such as The Joint Commission Perinatal
Keywords Core Measures and Baby Friendly Hospital Ini-
breast milk tiative, which both recognize the protection and
NICU value of mom’s own milk. The use of human donor
quality initiatives
milk in the neonatal intensive care unit (NICU) has
collaborative
increasing been expensive but worth the payoff with less
milk supply very low birth weight morbidity and mortality in
our large NICU. The purpose of the Mom’s Own
Milk (MOM) Bundle is a multidisciplinary, collabo-
Newborn Care rative approach to gently encourage and support
a mother’s decision to provide her precious milk
Poster Presentation for her baby in the NICU.
Proposed Change
The MOM Bundle uses quality initiatives through-
out the Women and Children’s Service line to ini-
tiate and maintain the mother’s milk supply. Im-
provements are focused on the barriers mothers
Virtual Special Care Nursery: A Cost Savings Idea
Michelle M. McFail, MSN, Purpose for the Program
RNC-OB, Baptist Health, Little he purpose of the virtual special care nurs-
Rock, AR
Keywords
T ery is to decrease the length of stay for these
patients while maintaining quality care.
special care
length of stay Proposed Change
late preterm infant 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
Newborn Care the neonatal intensive care unit (NICU) for monitor-
Poster Presentation ing within 24 hours of birth. The average length of
stay for the special care infant was 7 days. It was
decided that the differing needs of these infants
from full-term newborns could be provided for in
a virtual setting. Nurses would be trained follow-
ing evidence-based guidelines. The care would
be provided in the mother’s room or the well-baby
nursery.
Implementation, Outcomes, and Evaluation
Over a 6-month timeframe, information was gath-
ered, equipment purchased, protocols estab-
lished, and a plan was implemented to care for
the special care infant on the postpartum unit. The
JOGNN 2012; Vol. 41, Supplement 1
Proceedings of the 2012 AWHONN Convention
face when providing milk and discovering an in-
novative game plan to reduce those barriers.
Implementation, Outcomes, and Evaluation
Implementation of this quality initiative focuses on
staff and family education. After looking at the
average length of stay, baseline breastfeeding
rates, number of donor milk bottles used each
day, and fiscal expenditures spent on donor milk,
our goal is projected to decrease donor milk use,
decrease medical and surgical necrotizing ente-
rocolitis rates, and decrease length of stay.
Implications for Nursing Practice
The MOM Bundle is a collaborative approach to
increase the availability and volume of mothers’
milk in our Level III, 83-bed, NICU. Working to-
gether with our medical, nursing, and NICU sup-
port staff, we project an increase in mom’s own
milk, which benefits the mother, the infant, and the
hospital goals.
team estimated that within 24 hours after birth,
approximately 75% of late preterm infants were
admitted to the NICU prior to the implementation
of the special care nursery. After 6 months of im-
plementation, the admissions had decreased to
9%. Each year since implementation, the number
of admissions to the NICU has decreased for this
population. The length of stay has decreased from
7 days to approximately 2 days for this group as
well.
Implications for Nursing Practice
Nursing staff in the special care nursery are
trained to evaluate and intervene quickly based
on evidence-based protocols. This allows for the
infant to remain with the family. Having the in-
fant in close proximity increases the time avail-
able 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. This process increases
the nursing staff’s satisfaction about the care they
provide.
S43
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 mil-
E lion newborns in the United States receive
a diagnosis of clinical jaundice. The American of
Academy of Pediatrics has instituted guidelines
for the assessment and management of hyper-
bilirubinemia in newborns. 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 hyper-
bilirubinemia after discharge during the weekend
and holiday. Most infants with hyperbilirubinemia
who are discharged before 72 hours should be
seen within 2 days of discharge.
Proposed Change
Previously, discharged infants with hyperbiliru-
binemia who required follow-up on weekends and
holidays were seen in the emergency room, which
delayed evaluation and treatment. We sought to
identify infants at risk and streamline the evalua-
tion and treatment process by instituting a week-
end and holiday Bili Clinic on the mother-baby
unit.
Implementation, Outcomes, and Evaluation
To identify infants at risk, we instituted collection
of cord blood type and Coombs testing at deliv-
ery for mothers with blood type O positive or RH
negative blood types. Furthermore, 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 diag-
P nosis face many unexpected decisions: con-
tinue the pregnancy or proceed with early termi-
nation, comfort care or pursue neonatal intensive
care intervention, treatment options with second
opinions or withdrawal of life sustaining measures.
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.
S44 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
bin test performed and if the result was greater Martha Montes, BSN, RN,
than 6 a serum bilirubin specimen was collected. University of Illinois Medical
The goal was to identify those at risk of hyper-
bilirubinemia and initiate treatment in a timely man-
Center, Chicago, IL
Lourdes Notario, BSN, RN,
ner. The weekend and holiday Bili Clinic opened University of Illinois Medical
in April 2010. During the week, newborn health Center, Chicago, IL
care providers (from the departments of pediatrics Keywords
or family medicine) identified newborns requiring hyperbilirubinemia
outpatient follow-up on the weekend and holiday phototherapy
and initiated the process for pre-admission to the transcutaneous bilirubin (Tcb)
Bili Clinic, maintained a logbook, and informed Bili clinic
parents of required follow-up. Parents received an
information form with the follow-up appointment
to the Bili Clinic (scheduled anytime from 8:00 Newborn Care
a.m. to 4:00 p.m.). As parents arrived for follow- Poster Presentation
up, the staff activated the Bili Clinic process, noti-
fied the newborn health care provider of the new-
born’s arrival, and initiated procedures (weight,
transcutaneous bilirubin, or serum bilirubin) as re-
quested. Based on the test results, the decision
was made to provide further patient follow-up,
discharge home, or admit the newborn for treat-
ment. This process for at-risk infants bypassed
the emergency department and facilitated prompt
treatment at the Bili Clinic.
Implications for Nursing Practice
Evaluation is ongoing based on patient comments
and efficiency of workflow for nursing staff. Infants
received phototherapy in a timelier manner and
thus increased patient and nurse satisfaction, de-
creased overall costs, and promoted better out-
comes for the patient.
Proposed Change Becky Gams, RN, MS, CNP,
The University of Minnesota Amplatz Children’s University of Minnesota
Hospital’s Perinatal Palliative Care is a family-
centered, multidisciplinary program that provides
Medical Center, Fairview,
Minneapolis, MN
a continuum of medical, emotional, psychosocial, Keywords
and spiritual support through diagnosis, preg- comfort care
nancy, birth, and death. Throughout this process, palliative
loss
parents are supported in creating a plan of care
newborn
for their baby that is consistent with their goals and life-limiting
wishes. The program goals address the National fetal
Quality Forum’s Preferred Practices for Palliative
Care and support caregivers in meeting palliative
care outcomes. Newborn Care
Poster Presentation
http://jognn.awhonn.org
Gams, B. I N N O VAT I V E P R O G R A M S
Implementation, Outcomes, and Evaluation
Historically, care for these families was heroically
pulled together by a few dedicated and passion-
ate individuals. However, as the newly established
Fetal Diagnostic and Treatment Center’s patient
volume grew, the needs for families choosing to
continue pregnancy and newborn comfort care
were expected to grow as well. Steps to formalize
the program, led by the advanced practice nurse
leader, included a literature review, interviews with
leaders from established programs, development
of support from hospital administration and key
individuals willing to operationalize the program,
and creation of a multidisciplinary education pro-
cess. The palliative care approach is enhanced
by our established Pregnancy and Newborn Loss
program. Although current numbers are small, av-
eraging four per year from 2008 to 2010, eight fam-
ilies were served in 2011 (year-to-date). Families
Baby Cuddlers Make a Difference
Monica C. Kraynek, MS, Purpose for the Program
RNC-LRN, RN-BC, The he number of newborn infants treated every
Pittsburgh, PA T
Western Pennsylvania Hospital,
year at the Western Pennsylvania Hospital
for neonatal abstinence syndrome (NAS) has in-
Mona Patterson, RN, BSN, The creased more than 150% since 2004. Nurses con-
Western Pennsylvania Hospital, duct the Finnegan Neonatal Abstinence Scoring
Pittsburgh, PA
Tool every 2 hours to analyze the infant’s with-
Christina Westbrook, RN, BSN, drawal symptoms and determine if pharmaco-
MSN, MBA, The Western logic intervention is necessary and/or effective.
Pennsylvania Hospital, Up to 30% of infants may be managed without
Pittsburgh, PA
medication. Interventions for treatment of these
Keywords infants include medication and supportive care.
baby cuddler The purpose of the program, as a unit evidence-
neonatal abstinence based practice project, was to learn if the addition
length of stay of baby cuddlers as caregivers could affect the
length of stay required for treatment of these in-
fants.
Newborn Care
Poster Presentation
Proposed Change
A baby cuddler is a trained baby holder who
can fill the gaps when parents are not able to be
present. The cuddler provides an important com-
ponent of the developmental care for the hospi-
talized infant. The importance of human contact
and touch in the well being of all hospitalized in-
fants has been well documented. Baby cuddlers
on a daily basis held, rocked, and comforted the
infants suffering from drug withdrawal.
JOGNN 2012; Vol. 41, Supplement 1
Proceedings of the 2012 AWHONN Convention
commented that “this was the happiest and sad-
dest day of my life.” Data from patient satisfaction
surveys and multidisciplinary debriefings are dis-
seminated to the health care team. Within this sup-
portive formalized structure, a broad health care
team accommodates the individual needs and cir-
cumstances of each family in the program.
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 re-
cently established Fetal Diagnostic and Treatment
Center. Program scope, role definitions, respon-
sibilities for maternal and neonatal medical man-
agement, program access, and multidisciplinary
education will be described. A detailed birth plan
template, newborn comfort care orders, care con-
ference documentation, and process workflow will
be displayed.
Implementation, Outcomes, and Evaluation
Seventy-five infants were admitted to the depart-
ment with the diagnosis of NAS in the 1-year study
period from May 2009 to May 2010. 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. From May 2009 to Oc-
tober 2009, the average length of stay for infants
with NAS was 26.2 days without the baby cud-
dler program. From November 2009 to May 2010,
the average length of stay for infants with NAS was
22.4 days, a decrease in length of stay of 3.8 days.
After the official evidence-based project ended,
from May 2010 to April 30, 2011, the pediatric
unit cared for an additional 75 NAS patients. The
length of stay average was 23.9 days, a decrease
in length of stay of 2.3 days compared with the ini-
tial noncuddler group. Baby cuddlers completed
an orientation to their role and received education
on hand washing and Health Insurance Portability
and Accountability Act regulations. From initiation
of the project on October 1, 2009, to February
28, 2011, baby cuddlers have contributed 2,855
hours of cuddling to patients suffering from NAS.
Implications for Nursing Practice
Nurses have implemented a low-cost intervention
that decreases length of stay and, thus, affects
hospital finances and provides quality patient care
to a vulnerable population.
S45
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
A from the newborn nursery to the neonatal in-
tensive care unit (NICU) was identified in a Level
III NICU at a Magnet hospital. This offering will de-
tail the pragmatic strategies utilized to decrease
NICU admissions of high-risk transition newborns
and present specific obstetric-related diagnoses.
Proposed Change
To develop standards in clinical practice to pro-
mote 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 la-
bor. Nurses are critical to assess, plan, act, and
evaluate care for high-risk transition newborns to
improve clinical outcomes and increase efficiency.
Implementation, Outcomes, and Evaluation
A collaborative team approach was taken to es-
tablish clinical criteria to identify infants at risk of
transfer to the NICU. Standards were developed
for newborns delivered between 35 and 36 weeks
gestation, born to mothers with chorioamnionitis
or diabetes who received IV insulin during labor.
These infants, high-risk transition newborns, are
admitted to the NICU for up to 6 hours of obser-
vation. Glucose management, breastfeeding, and
newborn admission policies were revised to re-
flect new processes. The criteria and interventions
were standardized and embedded into practice. A
“Wait for Eight”: Improvement of Newborn Outcomes
by the Implementation of Newborn Bath Delay
Purpose for the Program
o improve newborn outcomes by implement-
T ing the evidence-based research to delay
bathing the newborn.
Proposed Change
To improve newborn outcomes, implementation
of evidence-based research was initiated. Imple-
mentation of bath delay showed that regardless
of gestational age, the incidence of newborns ex-
periencing hypothermia and hypoglycemia during
the transitional period was reduced by changing
the focus of unnecessary interventions.
S46 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
multidisciplinary approach was utilized to assure Judith Pfeiffer, BSN, RN-C,
all care providers involved with maternal–newborn Lehigh Valley Health Network,
care received education, including process flow
charts, algorithms, and reference cards. The cri-
Allentown, PA
Denise Keeler, BSN,
teria were communicated to the family prior to de- RNC-NIC, Lehigh Valley
livery to ensure inclusion with all aspects of care. Health Network, Allentown, PA
To foster family-centered care, families were made
aware of where their newborns would be admitted. Keywords
Since July 2008, full-term hypoglycemic newborn transitional NICU
transfers decreased 15% from the mother–baby transitional newborn nursery
unit to the NICU, the admission of high-risk transi- observational nursery
tion newborns to the NICU increased 27%, and the
transfer of all newborns back to the mother–baby
unit is about 80%. Newborn Care
Poster Presentation
Implications for Nursing Practice
Clinical criteria to identify newborns at risk of in-
stability during extrauterine transition of life were
standardized and embedded into practice. 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. Clinical autonomy
was maintained for the NICU nurse who provided
care to the newborn during the transitional time
frame. Standard processes and care requirements
enabled nurses in a NICU to make prudent and
timely decisions to improve neonatal outcomes.
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.
Implementation, Outcomes, and Evaluation Diana V. Lipka, RNC, BA,
To review the current practice and identify the pri- Baycare/Saint Joseph’s
oritization of the nursing task over the outcomes
of bathing, the newborn, newborn care guidelines
Women’s Hospital, Tampa, FL
Marcia K. Schulz, RNC, MS,
including revision of newborn order sets were es- Baycare/Saint Joseph’s
tablished. Reference to evidence-based research Women’s Hospital, Tampa, FL
and data collection post-implementation of guide- Keywords
lines were utilized. Multidisciplinary team actions newborn bath delay
involved evidence-based practice data regarding skin-to-skin
the effectiveness of newborn bath delay. Script- transition
ing to parents and families were created, which
included the development of crib cards in order
for clinical staff to facilitate the process change by Newborn Care
direct hands-on education. Poster Presentation
http://jognn.awhonn.org
Lipka, D. V. and Schulz, M. K.
Kimberly Pinkerton, MSN, RN, Purpose for the Program
RNC-NIC, IBCLC, Mission
Hospital System, Asheville, NC
Jennifer Wilkinson, BSN,
RNC-NIC, Mission Hospital
System, Asheville, NC
Keywords
low birth weight babies
breast milk
NICU
buccal care
Newborn Care
Poster Presentation
JOGNN 2012; Vol. 41, Supplement 1
I N N O VAT I V E P R O G R A M S
The description of the process from admission to
discharge identified the value in bath delay related
to skin-to-skin research. Global hospital staff edu-
cation was initiated and staff were presented with
advice to give to parents and families during new-
born care education. The value of skin-to-skin care
with transition, bonding, and breastfeeding was
emphasized. Our efforts were validated by the im-
proved outcomes of practice change of newborn
bath delay, which resulted in increased patient sat-
isfaction.
Implications for Nursing Practice
Historical review of newborn care delivery demon-
strated that nursing has shown to place prior-
ity on the completion of nursing tasks over the
Buccal Care with Colostrum in the Low Birth Weight Infant
here is overwhelming evidence in the literature
T that human milk is superior to any form of nu-
trition for the neonate. It contains immunological,
nutritional, and developmental properties that pre-
vent infection, provide individualized nutrition, and
optimize brain growth and visual development.
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. This population of patients in the
neonatal intensive care unit (NICU) is most vulner-
able to morbidities, including necrotizing enteral
colitis and nosocomial infections. Human milk de-
creases the incidence and severity of nosocomial
infections and necrotizing enteral colitis. It also
has been proven to protect against gastrointesti-
nal and respiratory infections. Its perfect combi-
nation of protein, carbohydrates, and plasma pro-
teins improves gastric emptying, which promotes
feeding tolerance. The purpose of this project is to
promote buccal application of mother’s colostrum
for low birth weight infants in the NICU.
Proposed Change
The nursing intervention of buccal application of a
mother’s colostrum potentially decreases the inci-
dence of certain morbidities and decreases the
length of stay of these fragile infants. The pro-
Proceedings of the 2012 AWHONN Convention
outcomes related to the newborn transitional pe-
riod. To improve newborn outcomes, implemen-
tation of evidence-based research was initiated
to foster practice change. The research of skin-to-
skin practice directly correlated the need to review
newborn care and practices thereof. The need to
review one such practice was the newborn bath.
Recognition of the importance of an uninterrupted
newborn transition resulted in positive newborn
outcomes and patient satisfaction. Implementa-
tion of bath delay showed that regardless of ges-
tational age, the incidence of newborns experi-
encing hypothermia and hypoglycemia during the
transitional period was reduced by changing the
focus of unnecessary interventions.
posed change in practice is to institute a policy
of buccal application of colostrum in the NICU.
The infants are being followed longitudinally for
outcomes related to this care.
Implementation, Outcomes, 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 1,500
grams) was developed and implemented in Jan-
uary 2011. Staff education was completed at staff
meetings via slide presentations. The completed
policy also includes an education sheet for par-
ents as a means of encouraging their participation
in this bedside practice.
Implications for Nursing Practice
Due to the limited availability of colostrum, moth-
ers are being encouraged to begin pumping within
6 hours of delivery and pump on a prescribed
schedule. We created syringe kits with detailed
instructions for the collection of a mother’s breast
milk to avoid waste. 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. Currently, longitudinal data
are being collected on the infant outcomes post-
treatment. Ongoing education of staff and parents
is imperative to the successful implementation of
this policy.
S47
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 informa-
T tion regarding the incidence of falls of infants,
the education strategies employed to decrease
the risk of falls, 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.
Proposed Change
Investigations were completed to identify trends
in the falls of infants. Staff and patient education
were developed utilizing the findings from incident
reports. Picture-based patient education was de-
veloped and posted in patient rooms for easy ac-
cess by patients and visitors.
Implementation, Outcomes, and Evaluation
Focused staff and patient education were imple-
mented in April 2010. In 2009, there were 5.83
falls per 10,000 live births, and in 2010 there were
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
C (CLABSI) are associated with increased mor-
tality and adverse outcomes in multiple systems
in the neonatal intensive care unit (NICU) patient.
All of the literature in the past 2 years regarding
CLABSI has shown that with the implementation
of evidence-based strategies, CLABSI can be sig-
nificantly reduced and in some cases completely
eliminated. In June 2009, a designated committee
at St. Joseph’s Women’s Hospital’s NICU began
reviewing central line care and the current liter-
ature concerning best practices for central line
management.
Proposed Change
A comprehensive program was developed, and
a timeline was established to implement multiple
interventions into the unit’s guidelines for the man-
agement of central lines.
Implementation, Outcomes, and Evaluation
Strategies included the following: (a) hand hy-
giene, (b) development and implementation of
central line insertion and maintenance bundles,
(c) validation for a team of nurses to perform pe-
ripherally inserted central catheter (PICC) inser-
S48 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
2.5 falls per 10,000 live births (8,568 live births in Ellen Fleischman, MBA, RD,
2010). Three falls occurred in 2010 prior to the im- RN, Sharp Mary Birch Hospital
plementation of staff and patient education. From
the implementation of education, there were no
for Women & Newborns, San
Diego, CA
falls for nearly a year. At the time of this abstract Monika Lanciers, BSN, RN,
submission, there were 0.43 falls per 10,000 live Sharp Mary Birch Hospital for
births (4,341 live births as of June, 2011). Women & Newborns, San
Diego, CA
Keywords
Implications for Nursing Practice falls of infants
The success of patient education may be at- health literacy
tributed to the goal of educating the patients and cultural barriers
visitors as well as providing education to illiter- staff education
ate or non-English speaking patients. The patient
education posters were translated into Spanish;
however, patients at Sharp Mary Birch Hospital Newborn Care
for Women & Newborns originate from a variety Poster Presentation
of countries and speak many different languages.
To optimize comprehension of patient education,
consideration should be given to utilizing pictures
in addition to text.
tion and dressing changes, (d) competency val- Jayne Solomon, MSN,
idation for all staff performing central line blood ARNP-BC, St. Joseph’s
sampling, (e) standardized central line tubing
change policy, (f) daily audits of all central lines
Women’s Hospital, Tampa, FL
Keywords
for integrity and necessity, (g) “scrub the hub” central line associated blood
care, (h) random audits, and (i) development of stream infections
a standardized sterilized PICC dressing change quality champion
central line bundle
kit. CLABSI rates in the NICU decreased progres-
hand hygiene
sively from 10.17 per 1,000-catheter days just be- random audit
fore the initiative begun in June 2009 to 5.84 per neonatal intensive care unit
1,000-catheter days by the end of the year. The
CLABSI rate for 2010 was 3.37 per 1000-catheter
days. The number of bloodstream infections de- Newborn Care
creased from 30 in 2009 to 10 in 2010, a 67%
decline. Poster Presentation
Implications for Nursing Practice
A comprehensive program of central line manage-
ment, led by a quality champion, is effective in
significantly reducing CLABSI in the NICU. The
designation of a quality champion who is respon-
sible for the initiative is vital to the success of this
program. This role includes overseeing and partic-
ipating in staff education, motivating and commu-
nicating with the team, random audits, and gath-
ering surveillance data for quality improvement.
http://jognn.awhonn.org
Bagby, K. and Bowen, S.
Kim Bagby, RNC, BSN, PCE,
University of Louisville
Hospital, Louisville, KY
Susanna Bowen, RN, BSN,
PCE, University of Louisville
Hospital, Louisville, KY
Keywords
kangaroo care
skin-to-skin contact
breastfeeding
barriers to kangaroo care
Newborn Care
Poster Presentation
Liza G. Cooper, LMSW, March Purpose for the Program
of Dimes Foundation, White
Plains, NY
Keywords
Kangaroo Care
skin-to-skin
staff resistance
parent awareness
Newborn Care
Poster Presentation
JOGNN 2012; Vol. 41, Supplement 1
I N N O VAT I V E P R O G R A M S
Kangaroo Care Increases Breastfeeding Rates
Purpose for the Program
or eligible mother–infant dyads, does imple-
F mentation of Kangaroo care at birth increase
breastfeeding rates compared to retrospective
breastfeeding rates?
Proposed Change
Kangaroo care, or skin-to-skin contact, began in
1979 in Bogota, Columbia, as a way to keep in-
fants warm and provide optimal nutrition following
birth. Research has shown that Kangaroo care has
many benefits for mothers and infants, including
increased breast milk supply and greater breast-
feeding success. The American Academy of Pedi-
atrics recommends skin-to-skin contact as a strat-
egy to increase breastfeeding success. In 2007,
a Kangaroo care program for healthy infants and
their mothers at the University of Louisville Hospi-
tal (ULH) was implemented. However, the philos-
ophy was not adopted as a standard of care until
2010. Strategies were developed to hardwire the
process and facilitate a change in practice that
supported the use of Kangaroo care.
Implementation, Outcomes, and Evaluation
Current literature was examined, policies were
revised, and staff expectations for participation
were established. Kangaroo care champions were
identified and assisted other staff with completion
of Kangaroo care competencies; also three staff
The Perfect Pouch: A March of Dimes Intervention
to Enhance Onset and Frequency of Kangaroo Care
he national evaluation results of the March
T of Dimes NICU Family Support program re-
vealed 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. Staff respondents also reported the
benefits of Kangaroo care include reduced stress,
enhanced comfort, and increased parent–infant
bonding, but only 8% of staff reported routinely
offering Kangaroo care to families. The March of
Dimes developed the Close to Me intervention to
increase the early onset and frequency of Kanga-
roo care in NICUs.
Proceedings of the 2012 AWHONN Convention
members received certification in Kangaroo care.
Documentation was improved to facilitate accu-
rate data collection. Breastfeeding and Kanga-
roo care progress was shared monthly with staff.
Breastfeeding initiation rates increased from 51%
in July 2010, to 74% in July 2011. During this time
the percentage of eligible infants who were placed
in Kangaroo care at birth increased from 60%
to 73%. The percentage of mothers and infants
documented as participating in Kangaroo care in
the mother–baby unit also increased from 35% to
51%. 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.
Implications for Nursing Practice
Implementation of the Kangaroo care initiative
improved breastfeeding rates in the population
served by the ULH. It is essential that all levels of
leadership support and monitor standard of care
practice at the bedside. In addition, accurate data
collection and a comprehensive educational pro-
gram are vital to support the initiative. Staff ac-
countability is crucial to any successful change
in practice. Our journey continues with further ed-
ucation and improved practices. This quality ini-
tiative is being shared with 57 birthing hospitals
throughout Kentucky.
Proposed Change
The Close to Me intervention includes parent ed-
ucation and awareness materials, staff education
materials, and items of comfort and encourage-
ment for families. 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.
Implementation, Outcomes, and Evaluation
Close to Me was unveiled in March of Dimes
NICU Family Support R
program sites nationwide.
In 2011, a national evaluation of Close to Me
was conducted in four NICU sites using an out-
side consultant who conducted staff focus groups
and surveys preintervention and postintervention,
S49
I N N O VAT I V E P R O G R A M S
Proceedings of the 2012 AWHONN Convention
parent surveys, and a special parent journaling
technique. 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. We worked
closely with a large team of NICU staff on adapt-
ing our materials for the full-term NICU infants and
the full-term, well-baby audiences of profession-
als and parents. Key findings from this work also
will be discussed.
Implications for Nursing Practice
Kangaroo care is a proven benefit to newborns
and parents. Staff resistance to its implementation
can be overcome with awareness, education, and
A New Look At Infection Control in the Neonatal Intensive
Care Unit
Purpose for the Program
o reduce infection rates in the neonatal inten-
T sive care unit (NICU) by 30%.
Proposed Change
To educate and implement policy to reduce the
NICU infection rates.
Implementation, Outcomes, and Evaluation
To change the way we look at preventing infec-
tions in the NICU, the aim of this project was to
recreate the policy and procedure on infection
control for the NICU. This project was started in
July 2008 after the unit joined the California Chil-
dren’s Quality Initiative in January 2008. The initial
goal for 2008 was to reduce infection rates in the
NICU by at least 30%. This project was completed
as follows: the California Children’s Quality Initia-
tive guidelines were collected and incorporated
into the current infection control policy for the unit;
each policy concerning infection control was re-
viewed; the last 5 years of peer-reviewed litera-
ture on infection control pertaining to neonatal in-
tensive care was reviewed, and pertinent informa-
tion was added to the policy and procedure; and
each multidisciplinary group in the NICU was met
with (for example the peripherally inserted central
catheter team). These teams compiled input, and
the information was added as appropriate to the
policy. Finally, the policy was reviewed and ap-
S50 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
hands-on instruction. Parents can learn to ask for
and advocate for this activity if they know about
it and its benefits early in their baby’s hospitaliza-
tion. Researching Kangaroo care by having par-
ents maintain a journal is appealing to parents who
have the opportunity to heal and process as they
participate in the study. Kangaroo care can be vital
to many if not all babies in the NICU, including full-
term babies and those in the NICU for a short stay.
The physiological, medical, and emotional bene-
fits of Kangaroo care are worth the additional time
required in educating staff and providing comfort-
ing space and opportunities for parents to Kanga-
roo care their infants.
proved by the medical director and delivered to Michele L. Carson, MSN-CNL,
the core group for the unit. RNC-NIC, UCSD Medical
Once the policy was finished, the staff members
Center, Del Mar, CA
Keywords
were educated through the creation of a six-panel
NICU
poster session on the policy. Each staff member CLABSI
was required to walk through the poster session quality initiative
and answer a set of competency questions that
pertained to the poster session. Also, a parent
agreement was created that centered on infec-
Newborn Care
tion control, which holds parents to the same stan-
dards as the nurses and doctors. During this time, Poster Presentation
specific audit tools were used to assess staff ad-
herence to the components of the policy. Overall,
the infection rate was reduced by 58% and audit
data showed adherence to be at 96% and greater.
These data were presented to the 2009 Califor-
nia Perinatal Quality Control Collaborative annual
meeting in Sacramento and at the hospital-wide
infection control committee. The policy was ap-
proved by the hospital-wide infection control com-
mittee and is under review for adoption on other
hospital units.
Implications for Nursing Practice
At this time our efforts are focused on sustaining
the gains. We are accomplishing this by review-
ing current evidence-based practice yearly and
changing practice accordingly, continuing to com-
plete audits on practice, and providing continuing
education to new and current staff.
http://jognn.awhonn.org
Woodson, L.
Linda Woodson, RN, BSN,
Baylor All Saints Medical
Center- Andrews Women’s
Hospital, Fort Worth, TX
Keywords
education
newborn safety sheet
snuggle time
hourly rounding
Newborn Care
Poster Presentation
Tessa Brown, BSN, RN, CLC,
Bristol Regional Medical
Center, Bristol, TN
Maggie Redmon, RN, C-EFM, supported by the American Academy of Pedi-
Bristol Regional Medical
Center, Bristol, TN
Keywords
skin to skin
early pumping
exclusive breast milk feeding
easy access for rental supplies who were exclusively fed breast milk at discharge
Newborn Care
Poster Presentation
JOGNN 2012; Vol. 41, Supplement 1
I N N O VAT I V E P R O G R A M S
What Do You Mean You Dropped Your Baby? Changing
and Hardwiring Nursing Practice to Eliminate Infant Falls
Purpose for the Program
n the first 2 years that Andrews Women’s Hospi-
I tal was open, we experienced eight infant falls.
The proposed changes were to hardwire hourly
rounding on all shifts, to educate families on safe
sleeping arrangement, and to promote maternal
rest.
Proposed Change
Our goal was to eliminate infant falls at Andrews
Women’s Hospital.
Implementation, Outcomes, and Evaluation
We implemented the project by first using a tally
sheet to identify common trends that occurred in
the falls of newborns. Then, we educated both the
newborn nursery and the postpartum staff on the
need to hardwire the hourly rounding on all shifts.
Next, we developed a newborn safety sheet that
described the elements of safe sleeping and re-
Supporting Breastfeeding in the Hospital: A Better Start
Purpose for the Program
reast milk feeding is the best option for in-
B fants and exclusive breast milk feeding is
atrics for the first 6 months of life. In addition, the
Joint Commission recently introduced PC-05, rec-
ommending exclusive breast milk feeding during
an infant’s entire hospital stay. Our goal was to in-
crease the rates of breast milk feeding during the
duration of the hospital stay and the rates of infants
to promote what is best for infants and comply with
the the Joint Commission’s recommendation.
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 pe-
riod. Second, we planned to begin encouraging
early pumping for mothers of infants that were not
breastfeeding well or were unable to nurse. We
then planned to make breast pumps and supplies
more readily available for our patients. Our staff
would then be educated on the changes.
Implementation, Outcomes, and Evaluation
Our unit began implementing changes to support
the breastfeeding relationship in the above men-
tioned areas. We began placing all breastfeed-
Proceedings of the 2012 AWHONN Convention
quired that both the mother and the significant
other sign the sheet because three infants had
been dropped by fathers. In addition, we empha-
sized with the newborn nursery staff and postpar-
tum staff how important it was to make sure that the
mother has the call bell within reach, even when
she is placed in a chair. We began an extensive
campaign to make sure that the mothers under-
stood the adverse effects of pain medication. In
addition, the postpartum registered nurse (RN)
would alert the RN nurse when the mother had
taken pain medication. Finally, we initiated “snug-
gle time” every day from 2:00 to 4:00 to promote
maternal rest without interruptions. The outcome
has been very positive, and it has been 1 year
since the last fall of a newborn occurred.
Implications for Nursing Practice
Education of families and hourly rounding are ab-
solutely necessary for keeping our infants safe.
ing infants skin-to-skin within the first hour and al-
lowed them to self-attach to the breast for the first
feeding, which has been shown to increase the
success of breastfeeding by approximately 80%.
Second, 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 med-
ical conditions. We then looked at how we could
support the use of breast pumps for our patient
population. 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. Finally, we educated our nursing staff on
the importance of supporting breastfeeding, al-
lowing them to become breastfeeding advocates
for our patients.
Implications for Nursing Practice
By implementing these changes, we were able to
provide the early intervention and support neces-
sary for our patient population. Patients are ex-
cited about the skin-to-skin process and our early
support and intervention. Our partnership with the
pharmacy has allowed our patients easy access
to breast pump rentals and supplies. Combining
these interventions has a great potential to in-
crease the rates of exclusive breast milk feeding
during the hospital stay and beyond.
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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
Babies, Bonding and Breastfeeding in the Post-Anesthesia
Care Unit: Innovative Family Centered Care in a Community
Hospital
Purpose for the Program
n many cultures, newborns are placed naked
I on their mothers’ chests immediately after birth,
which is viewed by many as necessary for the in-
fants’ survival. In most community hospitals, moth-
ers and infants are separated quickly after ce-
sarean birth and not reunited until hours later.
In collaboration with our post-anesthesia recov-
ery team, our obstetric nurses created a seamless
process to keep the mother and infant together
throughout the challenging postoperative period.
Proposed Change
In an effort to provide immediate skin-to-skin con-
tact and allow for early breastfeeding for mothers
and their healthy infants after operative deliveries,
the roles and responsibilities of the labor and deliv-
ery nurses were changed. 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.
Implementation, Outcomes, and Evaluation
A multidisciplinary team was formed that con-
sisted of labor and delivery nurses, postanesthe-
sia recovery team members, lactation consultants,
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 approxi-
R mately 5% to 10% of women self-report the
use of illicit drugs during pregnancy; however, uni-
versal testing in high-risk populations indicates
higher rates of illicit drug use. Facilities should es-
tablish their own testing protocols and unbiased
guidelines to identify when testing should occur
because the literature does not indicate consen-
sus on universal screening. A positive maternal
test result determines the initiation of the protocol
to test newborns.
Proposed Change
Meconium drug screening is considered the gold
standard for drug testing in the neonate, but be-
S52 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
and the director of women’s services. This team Lauren Griffin-Walls, BSN,
was formed to change the policies and proce- RNC-OB, Milford Memorial
dures to allow infants to remain with their mothers
after a cesarean birth and the immediate post-
Hospital-Bayhealth, Milford,
DE
partum surgical recovery period. A process was Jaclyn Lewis, RN-CPN,
developed to assist with the implementation of the Milford Memorial
new procedures and to educate and direct nursing Hospital-Bayhealth, Milford,
DE
teams involved with cesarean births. Evidence-
based best practice was used to guide staff ed- Keywords
ucation. The education incorporated the impor- babies
tance of skin-to-skin contact between the mother bonding
breastfeeding
and baby and early breastfeeding after an opera-
PACU
tive delivery. Evaluation revealed that keeping the
mother and baby together after cesarean birth in-
creased patient satisfaction, enhanced quality of
care, allowed skin-to-skin contact, promoted early Newborn Care
breastfeeding, and supported thermal regulation Poster Presentation
of the newborn.
Implications for Nursing Practice
Implementing “Babies, Bonding, and Breastfeed-
ing in the Post-anesthesia Care Unit” enhances
overall postpartum operative care, fosters team-
work between nursing units, and supports the
Association of Women’s Health, Obstetric and
Neonatal Nurses’ commitment to positive perinatal
outcomes.
cause of false positive test results and the length Tanyelle Bellamy, RNC, MSN,
of time to obtain confirmatory results it was iden- FNP-BC, Mountain States
tified that a practice change was necessary. Be-
cause of the sensitive nature of this test, accu-
Health Alliance, Johnson City,
TN
racy in patient test results is crucial. Increase Keywords
in false positive test results lead to question- drug testing
ing the truthfulness of the test. The goal was substance abuse
umbilical cord testing
to identify a process that provided ease of ob-
neonatal abstinence scoring
taining specimen sampling and accurate patient
test results. The proposed change was to imple-
ment umbilical cord tissue screening. The ad-
vantages of this process included samples be- Newborn Care
ing sent immediately after birth, receiving only Poster Presentation
confirmatory results, and a chain of custody. Be-
cause of the sensitive nature of drug testing and
possible legal ramifications, a chain of custody
http://jognn.awhonn.org
Bellamy, T. I N N O VAT I V E P R O G R A M S
was seen as a necessary piece of our process
improvement.
Implementation, Outcomes, and Evaluation
The plan was discussed and approved by the
neonatologists and pediatricians. Nursing leader-
ship met with pathology and lab directors to dis-
cuss switching the testing location from a local lab-
oratory to sending the tests to an outside reference
lab. Initial implementation began at a regional ter-
tiary care facility and a smaller community hospital
where the largest volumes of maternal substance
abuse were experienced. The outcomes focused
At Home with Your Baby
Deborah Raines, PhD, EdS, Purpose for the Program
RN, ANEF, Walden University, his community-based program is designed
Boca Raton, FL
Keywords
T to enhance parents’ competence and confi-
dence as caregivers after their infants’ discharge
NICU discharge from the neonatal intensive care unit (NICU).
simulation
caregiver competence Proposed Change
By enhancing parent confidence and compe-
tence, this program will improve infant, parent, and
Newborn Care overall family well being. The program also has the
Poster Presentation potential to decrease the use of health care re-
sources, such as 911 calls, emergency resources
visits, and hospital readmission.
Implementation, Outcomes, and Evaluation
The program is conducted in the department
for caregiver education and uses a preemie
high-fidelity simulator. The specific activities are
Making Kangaroo Care the Norm: Implementation of a New
Model of Care
Lynn Barabach, MSN, RNC, Purpose for the Program
Lakewood Hospital, Lakewood, n 2009, the Lakewood Hospital Birthing Cen-
OH
Joy Sedlock, MSN, CNM,
I ter embarked on the journey to obtain Baby-
Friendly, USA designation. It was identified that
IBCLC, Lakewood Hospital, a key component for a successful journey was
Lakewood, OH the implementation of Kangaroo care, or skin-to-
Kate Salmon, RNC, MSN, skin care, in the immediate postpartum period. In
IBCLC, Lakewood Hospital, the fall of 2009, the Birthing Center began training
Lakewood, OH the nurses on Kangaroo care and implementation
soon followed.
Keywords
kangaroo care
infant Proposed Change
childbirth Our goal was that all appropriate infants would
breastfeeding be placed in Kangaroo care shortly after birth and
would remain with their mother or the mother’s sup-
port person for 60 to 90 minutes. The time in Kan-
Newborn Care garoo care with the mother would facilitate tran-
Poster Presentation sition to extrauterine life and allow the infant to
self-latch at the breast.
JOGNN 2012; Vol. 41, Supplement 1
Proceedings of the 2012 AWHONN Convention
on increasing result turnaround times, potentially
decreasing the newborn’s length of stay, and de-
creasing rates of false positive test results.
Implications for Nursing Practice
The implications for the nursing practice in-
cluded the need for a standardized order set
for newborns experiencing neonatal abstinence
symptoms, which was developed in collaboration
between the departments of nursing and neonatol-
ogy. All nursing staff received in-service on neona-
tal abstinence scoring to help staff provide more
consistent and accurate scores.
adapted to the anticipated discharge needs
of the infant. The program accepts referrals
from all the NICUs in the county and from
the Health Department. The program began ac-
cepting referrals in January 2011. To date, the
evaluation of parents and staff has been over-
whelmingly positive and the funding has been
extended for a second year. Data are being col-
lected on the specific outcomes of parent confi-
dence and competence as caregivers as well as
on unscheduled use of health care resources on
infants.
Implications for Nursing Practice
The use of high-fidelity simulators may have a sig-
nificant role in the process of discharge teaching
in the NICU.
Implementation, Outcomes, and Evaluation
Nursing leadership worked with a nationally rec-
ognized expert on Kangaroo care to provide
education to the nurses. A 4-hour program on
Kangaroo care was developed and included dis-
cussion of the benefits, infant placement, and on-
going care of the infant, including assessment.
Placing the infant in Kangaroo care was demon-
strated to validate understanding. The electronic
health record was modified to include documen-
tation of time in and out of Kangaroo care and
with whom the infant was in Kangaroo care. Pa-
tient education included handouts on Kangaroo
care for distribution during prenatal appointments,
prepared childbirth classes, and breastfeeding
classes. Kangaroo care also is discussed dur-
ing tours of the Birthing Center. Pediatric, mid-
wifery, obstetric, and anesthesia providers were
educated about Kangaroo care and the Birthing
S53
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. As barriers were identified, nursing
leadership worked on the issues to minimize inter-
ruptions of Kangaroo care. The percentage of ap-
propriate infants in Kangaroo care following birth
is reviewed monthly. Between 90% and 98% of
appropriate infants are placed in Kangaroo care.
Infants also are placed in Kangaroo care shortly
after a cesarean birth while the mother remains in
the operating room. Anecdotally, lactation consul-
tants report a decrease in the incidence of delayed
latch and breastfeeding problems. Families have
Discharge Planning in the Neonatal Intensive Care Unit
Purpose for the Program
o improve parents’ ability to care for their in-
T fants at discharge.
Proposed Change
To implement the following improvements in the
neonatal intensive care unit (NICU):
r Cultural: More parental involvement. Parents
would hold infants every day. Parents get a
picture on admission. Long-term infants get
a journal with weekly pictures.
r Teaching: A parent admission and discharge
tool was created. Videos will be added to our
television system for parental viewing. Reg-
istered nurses will be held accountable for
daily teaching and documentation.
r Parental Accountability: Parents will be ac-
tively involved in teaching and take responsi-
bility for learning.
r Discharge map created: Outline discharge
teaching with daily accountability for up-
dates, holding, and teaching.
Implementation, Outcomes, and Evaluation
The clinical manager recruited two staff nurses.
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 hypothe-
T sized that we could improve postpartum well-
born baby care by switching from sponge bathing
to immersion bathing. A research review revealed
evidence supporting the theory that immersion
S54 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
reported increased satisfaction with their birthing
experiences.
Implications for Nursing Practice
Kangaroo care assists the infant with transition and
facilitates initial breastfeeding, it is beneficial to the
infant, mother, and family, and it is utilized through-
out the hospital stay and families are encouraged
to continue Kangaroo care at home, especially in
conjunction with breastfeeding. The use of Kanga-
roo care is truly a nursing intervention. This nurs-
ing intervention quickly became a model of care
for the Birthing Center.
included the following: an emotional approach, a Kathy J. Loughren, MSN,
literature review, and a discussion of unit expec- NNP-BC, Memorial Hospital
tations. Issues with discharge planning, parents
being unprepared to take their infants home, and
Miramar, Miramar, FL
Keywords
the associated risks were reviewed, along with neonatal intensive care unit
the American Academy of Pediatrics’ guidelines (NICU)
for discharge planning, including rooming in. Our
evaluations have been overwhelmingly positive.
Our parent surveys improved from the 30th per- Newborn Care
centile for discharge planning to the 99th per-
Poster Presentation
centile. Parents state that they feel at home within
the NICU and are prepared to care for their infants.
We offer all parents rooming in.
Implications for Nursing Practice
Discharge planning should begin on admission.
It is not only a teaching process but should in-
volve the parents in every aspect of their infants’
care. We must change our culture of isolation to
one of inclusion. The more involved the family is,
the more prepared they are to care for their in-
fant at home. Nurses must be held accountable
for discharge teaching on a daily basis. Parents
should be actively involved and accountable for
knowledge acquisition. Discharge mapping is an
excellent tool to ensure that parents have covered
all discharge information.
bathing improved temperature stability, bonding, Rebecca Heimann, RN,
breastfeeding, and parental education. The cur- Providence Alaska Medical
rent practice in the Providence Alaska Medical
Center Maternity Center is to perform sponge
Center, Anchorage, AK
Melissa Heath, RN, Providence
bathing under a radiant warmer on newborns Alaska Medical Center,
within 2 hours of birth in the absence of birth stress Anchorage, AK
http://jognn.awhonn.org
Heimann, R. and Heath, M. I N N O VAT I V E P R O G R A M S
or trauma. Parental involvement is minimal be-
cause of decreased mobility from anesthesia, ex-
Keywords haustion, and environmental or social distractions
bathing during the immediate postpartum period. Nurses
education also reported that breastfeeding and skin-to-skin
thermoregulation
bonding time often was interrupted to complete
infant stability
baths in the allotted 2-hour recovery time.
newborn care
Proposed Change
Newborn Care The Professional Practice Committee proposed
a policy and procedural change to immersion
Poster Presentation bathing founded on evidence-based research,
which incorporated these key principles:
r Delay infant baths 2 to 4 hours to estab-
lish thermoregulation and decrease nega-
tive side effects of hypothermia, including
increased oxygen consumption, respiratory
distress, and hypoglycemia.
r Stable temperature defined as 97.7◦ F to
99.5◦ F for 2 to 4 hours.
r Tub bathing appears to be more effec-
tive than sponge bathing at maintaining
body temperature and preventing tempera-
ture loss. Also, studies showed there is no dif-
ference in umbilical cord infection and heal-
ing rates and infants appeared more relaxed
and less agitated during tub baths.
Outpatient Newborn Hearing Screening Program
Nicole Giangregorio, BS, CLE, Purpose for the Program
LCCE, Sharp Mary Birch he Newborn Hearing Screening Program is a
Hospital for Women &
Newborns, San Diego, CA T California state mandated program requiring
all infants to have a hearing screening prior to dis-
Keywords charge. Sharp Mary Birch Hospital for Women &
outpatient Newborns additionally offers an outpatient hear-
community ing program for our well-baby population leading
hospital growth
to increased patient satisfaction and delayed ap-
pointment times.
Newborn Care Proposed Change
Poster Presentation To increase the number of patients receiving out-
patient hearing rescreenings, decrease the time
between the initial hearing screening and the
follow-up hearing screening, and increase rev-
enue.
Implementation, Outcomes, and Evaluation
The outpatient program allows our hospital to
schedule the follow-up appointment for all well-
babies prior to discharge, ensure a reminder call
is made, complete all necessary paperwork, and
guarantee an appointment well within the state
recommended 4-week timeframe. Compared to
our region, our outpatient no-show rate is consid-
erably lower. The region reported a no-show rate of
12.3% for July 2011 and Sharp Mary Birch Hospi-
tal for Women & Newborns reported a 0% no-show
JOGNN 2012; Vol. 41, Supplement 1
Proceedings of the 2012 AWHONN Convention
r Infants at risk of transmission of hepatitis B
and human immunodeficiency virus from ma-
ternal sources will be bathed within 2 hours
of birth.
Implementation, Outcomes, and Evaluation
The Professional Practice Council presented their
research and findings to the Nursery Committee
and received permission to proceed with a prac-
tice change. Currently, the Professional Practice
Council is developing a training video, policy, and
care competency. These tools will be presented
to the staff at regularly scheduled staff meetings.
Hands-on training of nurses and techs will be
conducted to assure comfort and competency in
practice. The goals for this project are consis-
tent immersion bathing per guidelines, increased
infant relaxation, increased parental involvement
and education covering proper positioning, tem-
perature regulation, and signs and symptoms of
infant distress.
Implications for Nursing Practice
Increased parental involvement in newborn care
results in greater uninterrupted bonding time, im-
proved breastfeeding, extended skin-to-skin con-
tact in the postpartum period, as well as improved
neonatal outcomes from decreased cold stress
and calmer stabilization.
rate (the overall program no show rate is currently
being calculated by the Regional Hearing Coor-
dinating Center). Each outpatient appointment re-
ceives a reminder phone call 48 hours prior to their
appointment. On the day of their appointment, the
family is received and escorted to the outpatient
clinic by a hearing screening technician. New par-
ents are relieved to come back to the hospital
where they gave birth versus going to a different
clinic and navigating a new health system. As a re-
sult, our patients are more satisfied. The outpatient
revenues previously went to other hospitals within
the community, and Sharp Mary Birch Hospital for
Women & Newborns now receives revenues from
the insurance companies and the state for Medi-
Cal and/or uninsured patients. Since the outpa-
tient program began in October 2008, we have
seen 382 outpatients with a steady increase each
fiscal year. The outpatient program is open to the
community at-large allowing for quicker access to
a follow-up hearing screening.
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 satis-
faction, and increased revenue.
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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
An Innovative Program to Support and Promote
Breastfeeding: What Have You Done for Me Lately?
Purpose for the Program
espite evidence for breastfeeding benefits,
D hospitals fall short in breastfeeding rates and
duration. Recent Centers for Disease Control and
Prevention data suggest less than 4% of U.S. hos-
pitals offer the full support necessary to meet
enduring, committed breastfeeding, and nearly
75% do not provide maternal support after dis-
charge. This challenges an institutional ability to
meet the Healthy People 2020 goals to have 81.9%
of mothers initiate breastfeeding, 60.6% breast-
feed at 6 months, and 34.1% breastfeed at 1 year.
The Surgeon General’s Call to Action to Support
Breastfeeding underscores this critical need, not-
ing low priorities for breastfeeding, and use of
nonevidence-based practices as barriers to en-
during breastfeeding.
Proposed Change
To create a comprehensive breastfeeding pro-
gram to meet the challenges stated above
Implementation, Outcomes, and Evaluation
Christiana Care Health System has built an endur-
ing lactation program available across the con-
tinuum of perinatal care aimed to meet these
action calls. Support is offered to mothers and
other perinatal clinicians by experienced lactation
consultants to overcome breastfeeding obstacles.
This program promotes the development of knowl-
edgeable mothers and health care providers. Our
facility maintains a free, breastfeeding hotline that
is staffed by lactation consultants. Mothers may
initiate a call at any time during their breastfeed-
ing experience when they encounter questions
or concerns. As part of this program, logs doc-
ument telephone conversations. To ensure that
S56 JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x
mothers are being offered relevant information, Lynn E. Bayne, PhD, NNP-BC,
logs were subjected to qualitative analysis, which RN, Christiana Care Health
determined the nature of maternal concerns. Ten
themes emerged and specific, predictable breast-
System, Newark, DE
Elizabeth Chance, EdD, RN,
feeding topics developed at key points during the Christiana Care Health System,
first year of life. Newark, DE
Lydia Henry, MSN, RNC-OB,
Data from 1,025 mothers who breastfed and called
CCE, IBCLC, Christiana Care
during 2009 were examined. Findings were then
Health System, Newark, DE
compared to the nurses’ perceived breastfeed-
ing barriers by care area, as defined in a sep- Keywords
comprehensive breastfeeding
arate performance improvement project. Results
program
of both projects clearly indicated the need to
Christiana Care Health System
initiate breastfeeding education activities during (CCHS)
prenatal classes, maintain momentum during the
inpatient phase, and provide anticipatory postdis-
charge guidance so that a successful support pro-
gram would be in place to meet the aforemen-
Newborn Care
tioned goals. Poster Presentation
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.
Inpatient nurses should address predictable ar-
eas of concern with new mothers, particularly
concerning milk supply, baby behaviors, and
pumping. Outpatient clinicians can offer antici-
patory guidance based on consistent patterns
of data across the postpartum period, such as
drug and diet interaction with milk, stooling pat-
terns, and weaning among other issues. Infor-
mation and available resources that are appro-
priately 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.
http://jognn.awhonn.org