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Improving Care for the Substance-Exposed Newborn and Family
INNOVATIVE PROGRAM Proceedings of the 2016 AWHONN Convention
Using the Plan-Do-Study-Act Model to Decrease NICU Admissions for Newborns Exposed to Chorioamnionitis Purpose for the Program hile moving toward Baby Friendly Hospital designation, we evaluated our practices and discovered that the practice of admitting stable newborns who were exposed to their mothers’ chorioamnionitis was not supported by evidence. To improve quality, satisfaction, and fiscal responsibility we recognized that this practice required a synergistic problem solving approach.
W
Proposed Change To develop, implement, and evaluate a process that provides increased surveillance and minimizes mother–infant separation by initiating sepsis screening and antibiotic therapy in the newborn nursery rather than in the NICU. The tradition of admitting newborns who were exposed to chorioamnionitis to the NICU was neither family-centered nor fiscally efficient. Furthermore, it interfered with bonding, affected breastfeeding, and overused NICU resources. Our interprofessional clinical leadership team recognized the need to align with Baby Friendly and family-centered care practices.
Implementation, Outcomes and Evaluation The team developed admission criteria, guidelines, tools, and communication strategies for chorio admissions to the newborn nursery. If stable at birth, skin-to-skin continued until the newborn was transferred to the newborn nursery for sepsis screening and antibiotic administration. Using the plan-do-study-act (PDSA) methodology, the process was tested, evaluated, revised, and fully implemented. Since implementation, more than 160 NICU admissions have been avoided, and quality metrics have been met.
Marianne D. Bittle, MSN, RNC-OB, Hospital of the University of Pennsylvania, Philadelphia, PA
Implications for Nursing Practice A transition process that provides familycentered, evidence-based, and cost-effective care for at-risk newborns has far-reaching benefits. At a magnet hospital with an emphasis on evidence-based research and best practice, nurses and their leadership have a responsibility to examine current practices and initiate those that are evidence-based and patient centric.
Keywords chorioamnionitis NICU PDSA baby friendly neonatal sepsis
Laura F. Scalise, BSN, RNCMNN, Hospital of the University of Pennsylvania, Philadelphia, PA Jessica Lazzeri, MSN, NEA-BC, Hospital of the University of Pennsylvania, Philadelphia, PA Michael Posencheg, MD, Hospital of the University of Pennsylvania, Philadelphia, PA
Neonatal Poster Presentation
Improving Care for the Substance-Exposed Newborn and Family Purpose for the Program ecause of the growing number of substance-exposed infants and feedback from service line customers (staff, health care providers, and patients), we began to examine ways to improve the care that we provide to the substance-exposed infant and family using a Lean Six Sigma process. This process led us to improve the following areas: consistency of nurse and parent/family education and standardization of neonatal abstinence scoring (NAS).
B
Proposed Change To standardize NAS scoring, train staff, and development an infant withdrawal brochure for nurses to use to educate families.
S28
Implementation, Outcomes and Evaluation To assess the NAS inconsistency, staff scored a standardized patient on a video using the Modified Finnegan Scoring system. Wide discrepancies occurred. Feedback by the staff indicated that they believed the tool was too subjective. The team compiled a Modified Finnegan Scoring Procedure document that defined each criterion and was read by all staff. The information also was presented verbally, accompanied by PowerPoint presentation, at the required annual inservice training. Another required assessment followed. During the second assessment, only a small number of staff still scored outside the acceptable range. Remediation and reassessment was required of these staff members. To address the
JOGNN, 45, S5–S36; 2016. http://dx.doi.org/10.1016/j.jogn.2016.03.027
Carol V. McIlhenny, MHSc, BSN, RNC-OB, Conemaugh Health System Memorial Medical Center, Johnstown, PA April Behory, RNC-OB, BSN, MSN, Conemaugh Memorial Medical Center, Johnstown, PA Tiffany Pugh, RN, BSN, Conemaugh Memorial Medical Center, Johnstown, PA Debra Lynch, BSN, RN, Conemaugh Memorial Medical Center, Johnstown, PA Dolores Gindlesperger, MSN, RN, Conemaugh Memorial Medical Center, Johnstown, PA
http://jognn.org
INNOVATIVE PROGRAM Proceedings of the 2016 AWHONN Convention
Keywords neonatal abstinence staff education family education substance use
Neonatal Poster Presentation
consistency of family education, the staff attended the Pregnancy Support Group at the local methadone clinic. Implications for Nursing Practice By clearly defining scoring criteria and educating staff, consistent NAS was achieved. Annual cali-
bration has been suggested. Family education about the substance-exposed infant can begin before birth by partnering with medication treatment programs.
SIDS Prevention Through a Back to Sleep Campaign Freda Horowitz Centor, MSN, RN, University of Alabama at Birmingham, Birmingham, AL Keywords SIDS Back to Sleep infant safe sleep
Neonatal Poster Presentation
Purpose for the Program n 1992, the American Academy of Pediatrics recommendation that infants be placed on their backs to sleep in order to reduce the incidence of sudden infant death syndrome (SIDS). Since the recommendation, the rate of infant deaths attributed to SIDS has been reduced overall by one half. However, a disproportionate number of African American infants continue to die due to SIDS, and Alabama has one of the highest infant death rates.
I
Proposed Change To develop, plan, and implement a Back to Sleep campaign in the University of Alabama (UAB) Women and Infants Center and in Birmingham’s African American community. Implementation, Outcomes and Evaluation In the research study component, the nurses on the mother-baby unit and in the newborn intensive care unit (ICU) taught the women about in-
fant safe sleep. Mothers then completed a written test. A total of 2,082 new mothers were enrolled in the study and demonstrated knowledge. With a follow-up phone call a few months later, we were able to reach 970 of those who had enrolled and 89% reported putting their infants on their backs to sleep the previous night. Next, we partnered with the Black Nurses Association of Birmingham for outreach and education. We gave talks, delivered literature, and answered questions at approximately 30 churches, health fairs, and community events, many with hundreds in attendance. Lastly, we placed a Back to Sleep banner on the backs of 25 city buses from May 2015 through July,2015. Implications for Nursing Practice Our evidence suggests that if our nurses are teaching a consistent message about Back to Sleep, our patients are gaining knowledge and are overwhelmingly adherent.
A Shared Governance Initiative to Implement an Infant Massage Therapy Program Rebecca J. Bell, MSN, RN, Maricopa Integrated Health Services, Phoenix, AZ LeAnn Hardin, RN, MSN, C-EFM, Maricopa Integrated Health Services, Phoenix, AZ
Purpose for the Program o use a shared governance model to find an economical way to improve patients’ and families’ experiences in the NICU. The team focused on using an evidence-based practice (EBP) method to positively affect infants’ quality of life through the implementation of a massage therapy program.
T
Proposed Change To improve neonates’ physiological stability, elimination patterns, weight gain, and sleep patterns by using Listening Touch, the M Massage technique, and therapeutic touch. Implementation, Outcomes and Evaluation The Massage Therapy Shared Governance team was formed by selecting committed, experienced
JOGNN 2016; Vol. 45, Supplement 3S
nurses who were consistently supportive of developmental care. Staff volunteered and completed infant massage certification training on their own time. The literature pointed to monitoring quality measures throughout the massage program. Between July 2014 and June 2015, 55 massage sessions were monitored. Staff members were educated on massage therapy during 45% of the sessions, and parents were educated during 48% of the sessions. The parents participated in the massage sessions 32% of the time. Listening Touch massages were given to 76% of the infants. The infants showed a positive response to massage sessions 93% of the time.
S29
Using the Plan-Do-Study-Act Model to Decrease NICU Admissions for Newborns Exposed to Chorioamnionitis Purpose for the Program hile moving toward Baby Friendly Hospital designation, we evaluated our practices and discovered that the practice of admitting stable newborns who were exposed to their mothers’ chorioamnionitis was not supported by evidence. To improve quality, satisfaction, and fiscal responsibility we recognized that this practice required a synergistic problem solving approach.
W
Proposed Change To develop, implement, and evaluate a process that provides increased surveillance and minimizes mother–infant separation by initiating sepsis screening and antibiotic therapy in the newborn nursery rather than in the NICU. The tradition of admitting newborns who were exposed to chorioamnionitis to the NICU was neither family-centered nor fiscally efficient. Furthermore, it interfered with bonding, affected breastfeeding, and overused NICU resources. Our interprofessional clinical leadership team recognized the need to align with Baby Friendly and family-centered care practices.
Implementation, Outcomes and Evaluation The team developed admission criteria, guidelines, tools, and communication strategies for chorio admissions to the newborn nursery. If stable at birth, skin-to-skin continued until the newborn was transferred to the newborn nursery for sepsis screening and antibiotic administration. Using the plan-do-study-act (PDSA) methodology, the process was tested, evaluated, revised, and fully implemented. Since implementation, more than 160 NICU admissions have been avoided, and quality metrics have been met.
Marianne D. Bittle, MSN, RNC-OB, Hospital of the University of Pennsylvania, Philadelphia, PA
Implications for Nursing Practice A transition process that provides familycentered, evidence-based, and cost-effective care for at-risk newborns has far-reaching benefits. At a magnet hospital with an emphasis on evidence-based research and best practice, nurses and their leadership have a responsibility to examine current practices and initiate those that are evidence-based and patient centric.
Keywords chorioamnionitis NICU PDSA baby friendly neonatal sepsis
Laura F. Scalise, BSN, RNCMNN, Hospital of the University of Pennsylvania, Philadelphia, PA Jessica Lazzeri, MSN, NEA-BC, Hospital of the University of Pennsylvania, Philadelphia, PA Michael Posencheg, MD, Hospital of the University of Pennsylvania, Philadelphia, PA
Neonatal Poster Presentation
Improving Care for the Substance-Exposed Newborn and Family Purpose for the Program ecause of the growing number of substance-exposed infants and feedback from service line customers (staff, health care providers, and patients), we began to examine ways to improve the care that we provide to the substance-exposed infant and family using a Lean Six Sigma process. This process led us to improve the following areas: consistency of nurse and parent/family education and standardization of neonatal abstinence scoring (NAS).
B
Proposed Change To standardize NAS scoring, train staff, and development an infant withdrawal brochure for nurses to use to educate families.
S28
Implementation, Outcomes and Evaluation To assess the NAS inconsistency, staff scored a standardized patient on a video using the Modified Finnegan Scoring system. Wide discrepancies occurred. Feedback by the staff indicated that they believed the tool was too subjective. The team compiled a Modified Finnegan Scoring Procedure document that defined each criterion and was read by all staff. The information also was presented verbally, accompanied by PowerPoint presentation, at the required annual inservice training. Another required assessment followed. During the second assessment, only a small number of staff still scored outside the acceptable range. Remediation and reassessment was required of these staff members. To address the
JOGNN, 45, S5–S36; 2016. http://dx.doi.org/10.1016/j.jogn.2016.03.027
Carol V. McIlhenny, MHSc, BSN, RNC-OB, Conemaugh Health System Memorial Medical Center, Johnstown, PA April Behory, RNC-OB, BSN, MSN, Conemaugh Memorial Medical Center, Johnstown, PA Tiffany Pugh, RN, BSN, Conemaugh Memorial Medical Center, Johnstown, PA Debra Lynch, BSN, RN, Conemaugh Memorial Medical Center, Johnstown, PA Dolores Gindlesperger, MSN, RN, Conemaugh Memorial Medical Center, Johnstown, PA
http://jognn.org
INNOVATIVE PROGRAM Proceedings of the 2016 AWHONN Convention
Keywords neonatal abstinence staff education family education substance use
Neonatal Poster Presentation
consistency of family education, the staff attended the Pregnancy Support Group at the local methadone clinic. Implications for Nursing Practice By clearly defining scoring criteria and educating staff, consistent NAS was achieved. Annual cali-
bration has been suggested. Family education about the substance-exposed infant can begin before birth by partnering with medication treatment programs.
SIDS Prevention Through a Back to Sleep Campaign Freda Horowitz Centor, MSN, RN, University of Alabama at Birmingham, Birmingham, AL Keywords SIDS Back to Sleep infant safe sleep
Neonatal Poster Presentation
Purpose for the Program n 1992, the American Academy of Pediatrics recommendation that infants be placed on their backs to sleep in order to reduce the incidence of sudden infant death syndrome (SIDS). Since the recommendation, the rate of infant deaths attributed to SIDS has been reduced overall by one half. However, a disproportionate number of African American infants continue to die due to SIDS, and Alabama has one of the highest infant death rates.
I
Proposed Change To develop, plan, and implement a Back to Sleep campaign in the University of Alabama (UAB) Women and Infants Center and in Birmingham’s African American community. Implementation, Outcomes and Evaluation In the research study component, the nurses on the mother-baby unit and in the newborn intensive care unit (ICU) taught the women about in-
fant safe sleep. Mothers then completed a written test. A total of 2,082 new mothers were enrolled in the study and demonstrated knowledge. With a follow-up phone call a few months later, we were able to reach 970 of those who had enrolled and 89% reported putting their infants on their backs to sleep the previous night. Next, we partnered with the Black Nurses Association of Birmingham for outreach and education. We gave talks, delivered literature, and answered questions at approximately 30 churches, health fairs, and community events, many with hundreds in attendance. Lastly, we placed a Back to Sleep banner on the backs of 25 city buses from May 2015 through July,2015. Implications for Nursing Practice Our evidence suggests that if our nurses are teaching a consistent message about Back to Sleep, our patients are gaining knowledge and are overwhelmingly adherent.
A Shared Governance Initiative to Implement an Infant Massage Therapy Program Rebecca J. Bell, MSN, RN, Maricopa Integrated Health Services, Phoenix, AZ LeAnn Hardin, RN, MSN, C-EFM, Maricopa Integrated Health Services, Phoenix, AZ
Purpose for the Program o use a shared governance model to find an economical way to improve patients’ and families’ experiences in the NICU. The team focused on using an evidence-based practice (EBP) method to positively affect infants’ quality of life through the implementation of a massage therapy program.
T
Proposed Change To improve neonates’ physiological stability, elimination patterns, weight gain, and sleep patterns by using Listening Touch, the M Massage technique, and therapeutic touch. Implementation, Outcomes and Evaluation The Massage Therapy Shared Governance team was formed by selecting committed, experienced
JOGNN 2016; Vol. 45, Supplement 3S
nurses who were consistently supportive of developmental care. Staff volunteered and completed infant massage certification training on their own time. The literature pointed to monitoring quality measures throughout the massage program. Between July 2014 and June 2015, 55 massage sessions were monitored. Staff members were educated on massage therapy during 45% of the sessions, and parents were educated during 48% of the sessions. The parents participated in the massage sessions 32% of the time. Listening Touch massages were given to 76% of the infants. The infants showed a positive response to massage sessions 93% of the time.
S29