A Pilot Project to Improve Neonataal

I N N O VAT I V E P R O G R A M SKlein, L. Proceedings of the 2012 AWHONN Convention A Pilot Project to Improve Neonatal Peripheral Intravenous Site Assessment and Documentation Newborn Care Lisa Klein, MSN, RNC-OB, RNC-LRN, CNS, Marymount University, Reston, VA Keywords neonatal nursing peripheral intravenous assessment documentation Paper Presentation Purpose for the Program here is currently no consistent protocol described in the literature for documentation of the nursing assessment of neonatal peripheral intravenous sites. Most authors concur that hourly assessments are the minimum frequency and indicate what the assessment parameters should be; however, they do not discuss a protocol for documentation of the assessments. Multiple authors and professional nursing groups have identified that problems exist in the care of peripheral intravenous sites in neonates. This project attempted to determine if nurses in a neonatal intensive care unit (NICU) could conduct and document an hourly evidence-based focused assessment of neonatal peripheral intravenous sites. T An additional purpose of the project was to obtain input from direct care nurses before initiating a change in practice. Critical care nurses perform multiple hourly assessments and care interventions on each patient. Additional documentation of five measurement parameters may not be realistic to add to the workload of the direct care nurse. By having the nurses who participated in data collection provide feedback regarding the complexity or simplicity of the instrument, they were able to evaluate the potential value of the process and the instrument to their care. Proposed Change Many NICUs use a system of charting by exception for assessment of peripheral intravenous sites in neonates. This project introduced a documentation form that includes the five evidence-based parameters to indicate the status of the peripheral intravenous sites. It attempted to determine if an instrument on which to document the assessment was relevant to the practice of the NICU nurses providing care. The project also determined the time needed to perform and document the peripheral intravenous site assessment and if that time was considered reasonable by the NICU nurses providing care. Implementation, Outcomes, and Evaluation The documentation form was piloted in a large suburban NICU. The short-term goal of this pilot project was to determine if the instrument on which to document the assessment and the time to perform and document it was deemed reasonable by the nurses providing care. The nurses are still participating in the pilot project. Early data suggest that the tool may be helpful but nurses are unsure if all of the parameters are necessary for an adequate assessment. Implications for Nursing Practice It is hoped that this project will stimulate further study of the individual assessment parameters to determine if any or all of them in a tool format are valid and reliable in predicting infiltrations and extravasations, which would be useful in improving patient outcomes. The Great Pretenders: Utilizing Evidence-Based Practice to Optimize Clinical Outcomes for the Late Preterm Infant Jaimi S. Hall, MSN, RNC-OB, Peninsula Regional Medical Center, Salisbury, MD Angela T. Houck, DNPc, RNC-nic, RN-BC, Peninsula Regional Medical Center, Salisbury, MD Keywords late preterm infant evidence-based practice Newborn Care Paper Presentation Purpose for the Program he late preterm infant faces many challenges associated with prematurity. In 2010, 99 late preterm infants (approximately 5% of the total birth volume) were born at Peninsula Regional Medical Center. Nearly 29% of these infants were admitted to the neonatal intensive care unit (NICU), and 12.8% were readmitted to the pediatric unit for complications associated with prematurity. The purpose of this program was to determine if adopting an evidence-based model of care utilizing the Association of Women’s Health, Obstetric and Neonatal Nurses’ Assessment and Care of the Late Preterm Infant Guideline will improve clinical T JOGNN 2012; Vol. 41, Supplement 1 outcomes and reduce late preterm infant neonatal intensive care unit admissions and readmissions to the pediatric unit. Proposed Change To adopt, institute, and practice Association of Women’s Health, Obstetric and Neonatal Nurses’ (AWHONN) clinical guidelines for every infant born between 34.0 and 36.6 weeks of gestation at Peninsula Regional Medical Center. Implementation, Outcomes, and Evaluation Data collection took place over a 6-month period to determine baseline rates of hypothermia, 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 difficulties, phototherapy, excessive weight loss, neonatal intensive care unit admissions, and readmissions to the pediatric unit. A multidisciplinary team developed the late preterm infant initiative utilizing AWHONN’s clinical guidelines. Components of the initiative included policy and order set development, predelivery and predischarge education, and individualized feeding plans. Beginning March 22, 2011, all late preterm infants were admitted to the intermediate care nursery and cared for with a nurse-to-patient ratio of 1:3 to 4. All aspects of the clinical guidelines were utilized based on the individual needs of the infant. Data collection on these infants began May 1, 2011. To date, 31 late preterm infants have been cared for under the new initiative. Eight of these infants were subsequently admitted to the neonatal intensive care unit (25.8%), and no infants were readmitted to the pediatric unit. The overall goal is to improve clinical outcomes while reducing admissions to the neonatal intensive care unit by 10% and readmissions to the pediatric unit by 5%, as compared with the 2010 rates. Implications for Nursing Practice As the primary bedside caregiver, nurses are extremely vested in their patients’ outcomes. This initiative has led to an increased staff awareness of this population, their unique needs, and the challenges they face. This knowledge, coupled with the utilization of evidence-based care, translates into improved clinical outcomes for the late preterm infant. This initiative also has improved teamwork and communication and has fostered relationships between nurses and other health professionals. Family-centered care is at the core of obstetric nursing as well as this initiative. Providing care that enhances family bonding, empowers parents, and improves clinical outcomes increases patient and nurse satisfaction. In this era of rising health care costs and nonreimbursement for preventable readmissions, it behooves nurses to adopt practices that anticipate and prevent possible sequelae related to late prematurity. Tackling Newborn Hypoglycemia in the Delivery Room: Utilizing Colostrum, Skin to Skin and State of the Art Policies Purpose for the Program ewborn hypoglycemia in the delivery room is a widespread challenge. Most often infants who are breastfed and are temporarily separated from their mothers receive formula as a quick fix to increase blood glucose levels. This approach not only decreases breastfeeding success, but it also exposes the newborn to unstable levels of glucose because of the formula’s stimulation of insulin production. Too many infants who are breastfed receive excessive amounts of formula within the first hour of life because their glucose values are checked before feeding, as soon as 15 to 30 minutes after birth. After witnessing a 40-minute-old newborn receive 40 ml of formula for a glucose level of 40, then promptly vomit, gag, and turn dusky, I decided it was time to act on my concerns that something was out of balance regarding the blood sugar/feeding issue. N Proposed Change To attain stable glucose levels in babies who are breastfed by giving infants drops of colostrum, feeding them before labs are checked, and keeping them in continuous skin-to-skin contact. I had recently become an international board certified lactation consultant, and that new level of knowl- S32 edge, coupled with my nursing experience, prepared me well for presenting my ideas to the administration. I also proposed that we establish ways to give colostrum to babies who were not ready to latch effectively. I wanted to rewrite the existing breastfeeding policy, have nurses adhere more vigilantly to our skin-to-skin policy, write a policy on prebirth hand expression of colostrum, and be a driving force to change many of the parameters of the newborn hypoglycemia algorithm. Pamela Kinney Tozier, BSN, RNC, CCE, IBCLC, Maine Medical Center, Portland, ME Keywords hypoglycemia diabetics hand expression colostrums skin-to-skin Newborn Care Paper Presentation Implementation, Outcomes, and Evaluation We have successfully implemented a new hypoglycemia algorithm that accepts lower glucose values initially, has the newborn feed first, and then the first glucose level checked by 90 minutes of age. We have implemented widespread hand expression of colostrum, before and after childbirth, for all of our diabetic patients who are breastfeeding, and we have maintained continuous skin-to-skin contact as a norm. The outcomes to date have been a decrease in separation of the mother and baby, higher newborn glucose levels, higher patient satisfaction, and better success of breastfeeding. JOGNN, 41, S1-S118; 2012. DOI: 10.1111/j.1552-6909.2012.01360.x http://jognn.awhonn.org 130 new patients/637 visits occurred. T. and increase breastfeeding and decrease breast pumping. In 2006. and 40 newborns greater than 37 weeks of gestation. Optimal treatment of this NAS population is hampered by the current lack of evidence-based standardized guidelines and protocols for pharmacologic management and care that promote improved outcomes for NAS patients. Currently. including a Premature Infant Nutrition Clinic Quality Assurance project. The American Academy of Pediatrics reported that 50% to 95% of infants exposed to opioids or opioid derivatives. the University of California San Diego Medical Center was designated as Baby Friendly. research of liquid fortification of the mother’s milk at discharge. APRN. but supply was decreasing. and Evaluation It was noted during the first year. ranging from one-time only to several visits 1 to 3 weeks apart. The goal was to improve the growth and nutrition of preterm infants. Mothers continued to need to pump. IBCLC. a plan is developed to help the mother reach the desired goal. Multiples data included 215 singletons. the Premature Infant Nutrition Clinic was established by a pediatrician and registered nurse. Outcomes. looking for ways to improve milk transfer. After the assessment and discussion. S33 . and 12 sets of triplets. NNP-BC.to 60-minute session. At the end of the 45. The Supporting Premature Infant Nutrition program was launched in 2007. Research that is more recent describes an increasing incidence of infants T JOGNN 2012. 104 newborns 34 to 33 6/7 weeks of gestation. Implementation. Supplement 1 exposed to harmful substances prior to birth. Fayetteville. the registered nurse performs a lactation consult and assesses the infant feeding. T Proposed Change In August 2008. the team sees 7 to 8 patients in a 4-hour session. 1 day a week. more breastfeeding.I N N O VAT I V E P R O G R A M S Lawson. These infants continued to require fortifiers. visits included infant’s growth and development assessments and discussions of the mother’s concerns. During the 3 years. 83 sets of twins. Lucas. Cape Fear Valley Health System. Utilizing a team approach. and the third year. Breast milk is an even greater benefit to the preterm infant because it provides infection prevention and promotes improved neurodevelopment. Premature Infant Nutrition Clinic Terry Lawson. There is a need to expand to 2 days to manage the increase in consultations. such as increased breast milk for longer duration of time. Vol. It is possible for just one nurse with a vision to apply evidencebased practice to achieve quality outcomes. and increased exclusive breastfeeding. Visits are individualized. Both parents were exhausted and overwhelmed. the second year. 90 newborns 30 to 33 6/7 weeks of gestation. most mothers were not successfully breastfeeding their premature infants. but we did not know how much or for how long. including heroin and methadone. RN. Care and management of these infants can be improved with practice guidelines and education. 83 new patients. the gestational age breakdown included the following: 46 newborns less than 30 weeks of gestation. 41. Proceedings of the 2012 AWHONN Convention Implications for Nursing Practice Labor and delivery nurses are the first line of defense in helping stabilize newborn glucose lev- els without the introduction of formula. Implementing Practice Protocols and Education to Improve the Care of Infants with Neonatal Abstinence Syndrome Katherine Y. CA Keywords human milk premature infant nutrition lactation consultant Newborn Care Paper Presentation Purpose for the Program he benefits of human breast milk for term infants outweigh formula. Implications for Nursing Practice Assuring best practice and performing research is exemplified by the projects in progress. decreased/no breast pumping. thereby upholding the standard of best practice. Outcomes have improved. 97 patients/183 visits occurred. DNP. A follow-up letter is sent to the primary provider with appointment highlights and recommendations. Babies exposed to opioids or opioid derivatives during pregnancy are at increased risk of developing NAS. and an international multicenter validation of a preterm growth chart. increase milk supply. San Diego. Both providers and nurses are involved in every aspect leading to increased patient and staff satisfaction. University of California San Diego Medical Center. It was noted that following hospital discharge. develop neonatal abstinence syndrome (NAS). NC Purpose of the Program he National Council on Alcoholism and Drug Dependency estimates that between 1% and 11% of babies born each year are exposed to illicit substances in utero. x http://jognn. University Community Hospital.01360. MN ders across a large multihospital health system to ensure that newborns who are at risk of head trauma or who have head trauma. MS.awhonn. with 2% to 44% improvement. University Community Hospital. Nurses were tested before and after participation in education about NAS. assessed. A subset of 10 nurses was evaluated using the FNAST with video of infants having NAS. perinatal palliative care infant advanced directives Newborn Care Poster Presentation Neonatal Head Trauma: Implementation of a Care Algorithm to Improve Safety Purpose for the Program o create a process by which newborns with head trauma or at risk of complications of neonatal head trauma are identified. and improved patient treatment goals. Newborn Care Paper Presentation Perinatal Palliative Care: Support of Mothers. providing nurses with specific information about a medical problem is correlated with improved adherence to best practice. are evaluated more closely to ensure their safety. to improve nursing assessment and care of the NAS infant.org . and Evaluation Implementation is in process and awaiting final approval of pertinent policies and procedures to support this program. Keywords NICU FNAST education Implications for Nursing Practice Evidenced-based clinical practice guidelines and education on NAS and the FNAST equip caregivers with the necessary tools to consistently and accurately assess an infant with NAS when using the FNAST. 2012. IBCLC. RN. and Evaluation This study was a nonexperimental. All 10 nurses who participated in the interactive video test scored 90% or higher against the FNAST criterion 1 week after participation in the educational project. Further. BSN. Infants and Families Purpose for the Program o support mothers.1552-6909. Proposed Change To create and implement a neonatal head trauma CNS-BC. Abbott Northwestern algorithm that is part of the newborn standing or. infants. Outcomes. Volunteer participation in the NAS educational project occurred in 81% of the neonatal intensive care unit nurses. pretest/ posttest study that evaluated change in nursing knowledge about NAS and use of the FNAST after the implementation of a quality improvement. educational project. and monitored differently with the goal of improving safety. FL Implications for Nursing Practice Provide care and support to both infants and mothKeywords ers going through this experience. Frances Fusco. JOGNN. and improve scoring accuracy with use of the FNAST. Implementation. J. Tampa. 41. and families through the Perinatal Palliative Care program. FL Theresa Bish. The evaluation will be based upon a patient satisfaction survey taken by telephone follow-up of patients discharged from the hospital.Hospital. Recent research shows that providing education to nurses can result in knowledge gained.2012. All nurses showed some improvement in scores on the posttest. Education also can equip nurses with the necessary knowledge to care for patients with complex medical problems like NAS. Tampa. MHS. Implementation. improved professional practice. T Proposed Change To enhance the existing bereavement program to include infants with low viability or no viability through palliative care. Minneapolis. RN. RN.1111/j. S1-S118.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Proposed Change To develop and implement evidence-based clinical practice guidelines and an educational program on NAS and the Finnegan Neonatal Abstinence Scoring Tool (FNAST). DOI: 10. T S34 Sandra Hoffman. Outcomes. and it is essential that infants at risk of complications of a difficult or instrumented delivery are identified and monitored more closely. Newark. such as subgaleal hemorrhages may manifest at birth or may occur over many hours. DE fants at less than 31 weeks gestational age. proper radiant warmer preheat and use. Clinicians are obligated to benchmark practices that may contribute silently to patient illness. and warming of caregiver hands. suggested that when infants are admitted to the NICU with hypothermia. and the neonatal head trauma algorithm was implemented across a large multihospital health system. Bayne. After a review of the literature. Body temperature should never be taken for granted. N. BSN. RNC. Staff and physician education was done regarding neonatal head trauma. their Newborn Care chances of survival decrease by approximately Poster Presentation 10% for every degree below 36◦ C. L. Donahue. The bundle included a timeout-style thermal checklist. Bear. Pamela Braithwaite. Across this time period. a neonatologist. increased room temperature. 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. NNP-BC. tal intensive care unit among inborn preterm inMiddletown. Implementation. In addition. A standardized approach can ensure the identification and closer monitoring of infants who may have an injury that may not manifest for many hours after delivery.Braithwaite. Supplement 1 mal intervention bundle was developed and implemented. including video and social media. 61% of the hypothermia fishbone diagram infants who were less than 31 weeks gestational root-cause analysis age had body temperatures less than 36◦ C at admorbidity mission and were classified as hypothermic using mortality the World Health Organization definition. Education about neonatal head trauma increases awareness of the risks. and Bayne. Vol. Help! I’m Cold! Improving the Warmth of Our Newborns Purpose for the Program ozy Cuties is a multidisciplinary performance improvement team convened to address hypothermia from birth to admission to the neonaNicole Donahue. MSN. PhD. RNC. DE infants were significantly lower than average in our neonatal intensive care unit (NICU) than the Keywords benchmark of 850 NICUs within the Vermont Oxpreterm ford Network. Literature was reviewed to establish potential causes. and Evaluation Neonatal head trauma can result in catastrophic outcomes. not to rewarm a cold infant. Proposed Change Root cause analysis using fish bone techniques was conducted on the first five cases of admission of hypothermia for each calendar month over the 12-month period prior to project inception. 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. E. The goal should always be to keep a warm infant warm. and helps to keep newborns safe. attention to application of pulse oximetry. independent of any disease conditions. Aggressive clinical staff education in labor and delivery and NICU was conducted using a variety of methods. and Evaluation Data were analyzed. promotes appropriate pain management. pediatricians. Ongoing monitoring for sustained improvement is now in place. P. A facility tour determined how many potential causes existed and coupled the potential cause with evidence-based interventions. change in transfer technique of newborn to a warmer from point of delivery. It is important to bring key stakeholders in a project to realize gains. and a neonatal nurse practitioner created a neonatal head trauma algorithm to become part of the newborn standing orders.. late onset sepsis is increased by 11% and odds of death are increased by 28%. infants who were less than 31 weeks gestational age were prospectively followed and the incidence of the outcome variables was collected. shortened infant time at point of delivery for both vaginal birth and cesarean birth. BSN. Outcomes. The evaluation of this change is ongoing. view of facility data over the past 5 years showed that the initial admission temperatures of these RN. ReLynn E. S35 . 41. A ther- Implications for Nursing Practice A multidisciplinary team can be an extremely effective agent of change. so identification of infants at risk and increased vigilance is important for patient safety. Christiana Care Health System. effective use of polyethylene wrap. Christiana Care Health System. Outcomes. Christiana Care. Complications. warming of surfactant. 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. DE C JOGNN 2012. Two large polyethylene studies of infants from 23 weeks to 30 completed weeks of gestation. a multidisciplinary team of neonatal and birthing clinical nurse specialists. Post-implementation. x http://jognn. and Evaluation Three to five times per day.org . Our breastfeeding initiation rate is 87. RN. T Proposed Change For 10 years. schedule the clinic visits at discharge. MS. the daily care of their infants. documentation.9%. RN.000 in salaries and mileage reimbursement. IBCLC. Maine Medical Center. and communication of education to better prepare parents for discharge. IA Keywords lactation program exceeding national and state breastfeeding rates Newborn Care Poster Presentation Implications for Nursing Practice The advantages of breastfeeding are well researched and well documented. Our lactation consultants can see five more infants per day or 25 more per week. which represents a savings of more than $140. as well as chart audits were used for measurement and feedback.6% as compared with the state’s 73. JOGNN.6%. Mary Greeley Medical Center. 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. 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. Portland.9% initiation of breastfeeding and a 6-month breastfeeding duration of 60. We are ahead of the Healthy People 2020 goals of an 81. S1-S118. Involve parents in the plan of care. jaundice. Our service model decreases hospital readmission rates and promotes exclusive breastfeeding with increased productivity and decreased cost. which makes it possible to provide second visits for those clients who need them. Implementation.2012. Most lactation programs have lost state funding in recent years and are now funded by hard-to-find grants. Our lactation consultants cross-train to the discharge planning position of the Birthways Lactation Services program where they round with the pediatricians. Implementation. it was determined this was a costly way to deliver care even with funds provided by a grant and some insurance reimbursement. We believe our outcomes reflect the success of the program.S. by community benefit dollars. We believe our program model is the best practice and is leading the way in breastfeeding promotion and support of the American Academy of Pediatrics Policy Statement and the U. Ames. 2012.3% (one of the best in the state) as compared with the national rate of 17%. staff and patient satisfaction. Our home visit model took 3. timing of education. Angela Carswell.1552-6909. Geraldine Tamborelli. and lactation evaluation.2 full time equivalents. and provide a discharge feeding plan for babies with feeding problems. and our clinic model takes 1. Eight years ago. or as in our hospital’s case. 41. Surgeon General’s Call to Action to Support Breastfeeding. I Proposed Change To standardize teaching. the coordinator of the lactation program and her team perform checks S36 that include weight.01360. and their personal preferences early on. multidisciplinary Newborn Care Poster Presentation Birthways Lactation Services: A Model for Breastfeeding Support Purpose for the Program he purpose of the Birthways Lactation Services program is twofold. Outcomes. We also want to increase the lactation consultant’s productivity while decreasing full time equivalents and cost.1 full time equivalents. Our 6-month breastfeeding rate is 79. and Evaluation Implementation using Plan-Do-Study-Act cycles. Outcomes.1111/j.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Welcome Aboard and Homeward Bound: The NICU Family’s Journey for a Safe Voyage to Discharge Purpose for the Program mprove parent and staff satisfaction with the discharge process and complex follow-up care for the very premature or sick infant.awhonn. DOI: 10. At that time we started the clinic model and were encouraged by the positive results. We want to increase breastfeeding initiation and duration rates and thereby improve long-term health for every infant. and Evaluation Prior to implementation. Columbus. Both are transported to the postanesthesia care unit. A Proposed Change To improve communication between providers and mothers. Infant Feeding Plan: An Innovative Documentation Tool to Improve Communication between Caregivers and Families Jennifer Peterman. to discuss maternal newborn feeding preferences. and Evaluation The implementation was started by staff nurses who considered the evidence-based practice of Kangaroo care to be best for the newborn. Throughout the infant’s stay. During 2010. A. both the nurse and mother discussed.I N N O VAT I V E P R O G R A M S Keller. RNC. Implications for Nursing Practice Empowering nurses to change practice to overcome traditional barriers of medical care to promote the empowerment of motherhood. Supplement 1 document. Alicia Brenneman. A. and a baseline set of vitals is obtained on the infant. The staff stated that if the vaginal birth infant could benefit from skin-to-skin. Providers commented that the plan is convenient and useful in practice. an innovative. patients report feeling that their infant feeding choices are respected and that the use of this plan prompts infant feeding discussions. a mutually agreed upon feeding plan was created and signed by both the mother and the nurse. BSN. Columbus. The practice of Kangaroo care has been well adopted in our setting. Once feeding preferences were identified. and ease the transition for intrautercesarean birth ine to extrauterine life. BSN. the plan was located at the infant’s crib. and Brenneman. 41. Patients report they would initiate Kangaroo care with their next birth. S37 . PA Keywords breastfeeding infant feeding plan patient–family centered care Newborn Care Poster Presentation Purpose for the Program lack of communication was identified surrounding a mother’s feeding decision and multiple health care providers. If any changes to the feeding plan were needed. then we should adopt the practice with the cesarean birth infant. breastfeeding rates were 68% and during the year postimplementation. Outcomes have been measured by patient satisfaction and stable infant temperatures during the time frame. Outcomes. 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. Outcomes. IBCLC. Proceedings of the 2012 AWHONN Convention Operation Kangaroo Care Purpose for the Program angaroo care is recommended in the Guidelines for Perinatal Care for stable newborns. infant feeding plan documentation tool was created to identify a mother’s preference for feeding her newborn from birth through discharge. Outcomes and evaluation are ongoing Prior to the implementation of the feeding plan. RN. breastfeeding rates have continued to increase to 74%. Anecdotally. OH called Kangaroo care) with the mother has been shown to maintain skin temperature regulation Keywords of the newborn. Implementation. The staff started Poster Presentation to initiate Kangaroo care in the postanesthesia care unit to provide all the benefits to the mothers who had cesarean births. Staff began by placing the infant skin-to-skin after moving the mother from the operating room table to a hospital bed. This lack of communication resulted in a mother’s perceived lack of respect by providers regarding her preference for newborn feeding. RNC. To address this issue. Providers also noted a large variation between provider practices related to newborn feeding and maternal preference. initial checks are preformed. 75% of all mothers who gave birth vaginally Newborn Care participated in skin-to-skin care. The development of the individualized plan began at maternal admission. The mother-infant pair is left skinto-skin for the next 60 to 90 minutes. and signed the revised feeding plan. OhioHealth. infants had been removed from the warmer after being wrapped with warm blankets and a hat and given to the mother to hold or breastfeed. crib side. OH K Proposed Change Before the initiation of skin-to-skin in the postanesthesia care unit. Philadelphia. and the Joint Commission recognized it as a best practice model of care. This process was not satisfying to the staff. CNP. increase initiation of successful Kangaroo Care breastfeeding. representatives from each provider group involved in newborn care collaborated on the creation of the infant feeding plan JOGNN 2012. a crib side infant feeding plan documentation tool was implemented. Anne Keller. The act of placing the infant skin-to-skin (also Grant Medical Center OhioHealth. Vol. updated. MS. Hospital of the University of Pennsylvania. Implementation. with the use of a scripted narrative. Late preterm infants gained weight appropriately and their mothers reported sustained breastfeeding. IBCLC. Obstetric and Neonatal Nurses’ 2010 Late Preterm Infant EvidenceBased Practice Guidelines research study.01360. RN-BC. monitored by ap- S38 proachable staff and expert professionals. This tool gave nurses an opportunity to dialogue with the infants’ mothers regarding feeding options and changes in infant feeding as needed. pediatric surgery.1% of live births (in 2008) and the rate at our hospital was 7. the tool served as a contract between the mother and the providers to ensure that the mother’s feeding preference plan was implemented.456 births/year in 2010). DOI: 10. Columbus. Riverside Methodist Hospital. RN. Patient–family centered care is based on respect and honest communication between providers and families. BSN. especially breastfeeding. Additional benefits included referrals to lactation. 2012. Late preterm infants often appear to be able to breastfeed successfully during hospitalization.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Implications for Nursing Practice This initiative provided an opportunity for nursing to re-energize their commitments to patient communication and infant feeding. Ohio. MS. RNC.2012. commitment occurred in this hospital’s outpatient setting to measure and improve post-discharge care of late preterm infants who breastfed. monitored by approachable staff and expert professionals is an effective means to continue and grow client relationships. 41. Implementation. IBCLC. and behavioral services.7% (of 6.x Kathleen H. Implications for Nursing Practice Accessible community service. free service. Also. As 1 of 15 sites for the Association of Women’s Health. Doctors Hospital-Ohiohealth.org . pediatrics. the following formula was used: Numerator – number of late preterm infants who gain weight of more than 0. Columbus. RN.5 ounces at more than 5 days of age and thereafter. Bright. Over 12 months. Denominator – total number of late preterm infants consulted/weighed. BSN.1111/j. OH Keywords late preterm breastfeeding weigh Newborn Care Poster Presentation http://jognn. OH Whitney Lenger Mirvis. Identify late preterm infants who return for repeat weight measurement. OH Joyce Sheppard. 151 individual late preterm infant weights were measured: 116 had repeated weights and 99% demonstrated weight gain (monthly averages). An accessible weigh station was evaluated to be an effective pathway to ongoing care and support for late preterm infants. and generate monthly progress reports. The tool also served as an easy way to communicate to any provider caring for the infant. Columbus. L Proposed Change To ensure a successful continuum of care for the postdischarge late preterm infant via a community resource where 90% of late preterm infants will gain weight after events of lactation consultation and first weight measurement. In Columbus. Women’s Health Services. CNS. but this may not be sustained following discharge.awhonn. OH Jane Lamp. nurses were able to review with the family the evidence associated with optimal infant feeding. (hence. JOGNN. S1-S118. Monitor at-risk groups for anticipated problems and provide a portal for continuing care. Riverside Methodist Hospital. track weight gain.1552-6909. their nickname “the great imposter”). Riverside Methodist Hospital. Columbus. At admission. the incidence of late preterm infants who breastfed was 9. A Baby Weigh Station: Continuum of Care for Late Preterm Breastfeeding Infants Purpose for the Program ate preterm infants who breastfeed are the largest segment of preterm infants. and Evaluation Utilize a baby weigh station within a user-friendly lactation support center to offer a community accessible onsite. IBCLC. Outcomes. To estimate the total number of late preterm infants who were consulted and weighed on more than one visit. RN. Georgetown University Hospital. Starrels. RN. Ryan. Georgetown University Hospital. BSN. MSN. It is the responsibility of us all to help mothers be successful and promote the recommendations of the Association of Women’s Health. MBA. and Wurster. hospital supplementation. RNCOB. Obstetric and Neonatal Nurses. The outcome was that our exclusive breast milk feeding rates increased. and the Joint Commission for exclusive breastfeeding. Department of Health and Human Services. and staff within women’s services. U. RNC-MNN. A. BSN. Wurster. Washington. IBCLC. Evidence-based practice describes this choice.S. This may improve exclusive breast milk feeding rates because of the effect that this has on patients. RN. Georgetown University Hospital. MSN. IBCLC. RN. Proposed Change We want to provide best patient care.. C. RNC-OB. M. RN-BC. A data collection tool was created to monitor and track exclusive breast milk feeding rates. Vol. It takes our village to educate the mother. C. Presbyterian Hospital. obstetricians. L. Washington. 41. We also are utilizing a patientbased survey to evaluate the effectiveness of the interventions. In May 2010. The topic of change regarding exclusive breastfeeding. NC Keywords exclusive breastfeeding Newborn Care Poster Presentation Purpose for the Program xclusive breastfeeding is best for the infant and mother.. American Academy of Pediatrics. and education for S39 . RN. DC Carol A. Charlotte. we have a unit research council.Dohnalek. O. Washington. Howland.. NC Diane Slough. the following interventions were completed: r r r r Keywords exclusive breastfeeding exclusive breast milk feeding breastfeeding rates Joint Commission perinatal core measure r Newborn Care Poster Presentation r r r r r Creation and implementation of Donor Pasteurized Milk Policy. L. and Evaluation Hospital. Centers for Disease Control and Prevention. These programs also encourage positive role modeling of supportive breastfeeding attitudes. Presbyterian Healthcare. Ryan. DC Margaret Howland. Within our shared governance structure. MSN. Proposed Change Over an 18-month period interventions were implemented to increase exclusive breast milk feeding rates by at least 10%. DC Lauren O. We realized our shortfall and discussed ways to improve our rate. and pediatricians Education related to alternative breast milk feeding methods Outside speaker (international board certified lactation consultant) that moderated dis- cussion of obstacles to exclusive breast milk feeding Feeding care plans (for complicated situations) developed collaboratively with nurses and international board certified lactation consultants Implementation of mother and newborn “quiet time” These interventions were implemented and the result was an increase in the staff’s knowledge and skills. DC r T at an urban academic hospital. Exclusive Breastfeeding: “It Takes Our Village” Julie Delcasino. World Health Organization. Washington. family. E. Many of the interventions included in our program are directly aimed at increasing breastfeeding knowledge of our staff and patients. Heer.. Georgetown University Hospital. Purpose for the Program NE-BC. The low incidence of exclusive breastfeeding is partially due to a lack of breastfeeding knowledge among health care professionals. Implications for Nursing Practice Education is a major aspect of our initiative to increase exclusive breast milk feeding rates. Georgetown University o increase exclusive breast milk feeding rates Hospital. DC To implement this program. our exclusive breastfeeding rate was 37%. Outcomes. all nurses attended mandatory education session Implementation of 24-hour rooming in (no separation of mothers and newborns via standard nursery) Survey given to patients to identify the most popular reasons for supplementation Journal clubs discussing breastfeeding issues Consultations with lactation consultants at other facilities Increasing rates and duration of initial skin-toskin contact and first breastfeeding session Daily patient rounds and assessments by international board certified lactation consultant Mandatory interdisciplinary breastfeeding education for all nurses. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Increasing Exclusive Breast Milk Feeding Rates at an Urban Academic Hospital Laurie Dohnalek. DC r Cynthia Heer. BSN. thus changing practice and creating confidence. Charlotte. Washington. but who can say their hospital truly promotes exclusive breastfeeding? We are a 600-bed hospital with more than 7. RN. DC. IBCLC. Educational programs that increase nurses’ knowledge and improve attitudes toward breastfeeding promote accurate and reliable delivery of breastfeeding information and skills to the mothers.000 births/year. FILCA. Supplement 1 stetricians and Gynecologists. Elizabeth Starrels. Washington. BSN. Georgetown University Implementation. American College of Ob- E JOGNN 2012. Burrell. infant. “You need your sleep at night. we have the Perinatal Quality Collaborative of North Carolina for exclusive breastfeeding. infants. can be a powerful education tool as well as parental education through verbal and written educational materials. and community were discussed.x Courtnie J. Safe sleep education was added to the March of Dimes notebook.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. In North Carolina. One way to accomplish this goal is by reducing the rate of fetal and infant deaths. parents. it’s the lactation consultant’s job. Implementation. Integrating evidence-based findings into practice will facilitate further involvement into addressing the higher incidence of sudden infant death syndrome in the African American population.01360.” Extensive education was needed for women’s services staff. The Perinatal Quality Collaborative of North Carolina’s well-baby track focuses on supporting mothers’ choice to provide exclusive breastfeeding for their term infants. Implications for Nursing Practice The expectation is to provide consistent safe sleep education to the parents and to model safe sleep positioning. Benefits of breastfeeding for the mother. Outcomes and Evaluation The nurse educator and lactation consultant developed an education program for all women’s services staff. Now I Lay Me Back to Sleep . physicians. Nurses are to model safe sleep positioning at least 24 hours prior to discharge and provide parental education on SIDS and SIDS risk reduction. which all parents of infants admitted to the neonatal critical care center receive. An education record is signed at discharge acknowledging that the information was reviewed. 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. One inservice was on SIDS and SIDS risks in the term newborn and the other addressed the needs of the premature infant. After discharge the charts are retrospectively audited for safe sleep education and supine positioning at least 24 hours prior to discharge. It has been proven that supine sleeping is the greatest factor in reducing the risk of SIDS even though many nurses still feel more comfortable placing the baby prone. We began with a literature search. Our council consists of staff nurses from the departments of mother–baby and gynecology. such as back sleeping.1111/j. Implications for Nursing Practice We want to provide the best practice and the literature supports exclusive breastfeeding. The nurse educator and lactation consultant are also committee members.1552-6909. “Breastfeeding is not our job.org . Many examples of hospital practices that decrease success of exclusive breastfeeding were recalled. Once the infant is transitioned to an open crib. children. Skin-to-skin care and rooming in were discussed. . from 2003 to 2007. Henrico Doctors’ Hospital. . 2012. . Implementation. We became an active member of the Perinatal Quality Collaborative of North Carolina project for exclusive breastfeeding.awhonn. As obstetric nurses. Richmond. Hospital nurses are the first professional role models for new parents. S1-S118. Articles from the literature search were presented. Data collected will be used to validate success of the program and to encourage the staff continued participation and support. we have power to educate and support mothers and families to make informed decisions about their individual infant’s care. DOI: 10. and Evaluation The safe sleep task force was initiated and a hospital policy on safe sleep was written. RNC. In Virginia. the infant should be placed in a supine position unless a physician’s order indicates otherwise. VA Keywords SIDS safe sleep model Newborn Care Poster Presentation http://jognn. 41. This is reviewed with the parents prior to discharge.Safely Purpose for the Program ne of the Healthy People 2020 goals is to improve the health and well being of women. there were approximately 78 infant deaths/year due to sudden infant death syndrome (SIDS). Henrico Doctors’ Hospital. Modeling suggested behaviors. This rate is greater than the national average. and families. and families. Richmond. Outcomes. The staff received mandatory in-services regarding SIDS to ensure consistency in parental education. RN.” What about labor and delivery nurses who say. O S40 JOGNN. A little formula never hurt. The major health care organizations that recommended exclusive breastfeeding were cited. Proposed Change Infants are no longer able to have stuffed animals or extra blankets in the incubator or crib. VA Diane Stairs.2012. SIDS education is also offered at infant cardiopulmonary resuscitation classes. and postpartum (LDRP) unit. enhances attachment. I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Implementing Skin-to-Skin Care in a Baby-Friendly Community Hospital Jennifer L. Level Three. metropolitan NICU. TX Keywords cue based feeding infant driven feeds NICU feeding Newborn Care Poster Presentation Purpose for the Program he purpose of this program was to implement cue-based feeding in our neonatal intensive care unit (NICU). E. and of documentation of mother education on benefits of skin-to-skin care. A.. first in a small group interactive setting and later followed with a video and discussion format. RN. Baylor University Medical Center Dallas. and promises long-term benefit to new families. 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. Mothers were assured that anyone. improved respiration and oxygen saturation. Several studies have come out to support that a cue-based feeding approach. A cue-based feeding approach tailors the progression of oral feedings for each individual. Implications for Nursing Practice The practice of skin-to-skin care as a component of our baby friendly philosophy contributes positively to neonatal transition. Howland. and Evaluation Health First. Studies have reported benefits of skin-toskin care of the newborn to include reduced crying.. and Wurster. and encouraged during the entirety of the postpartum stay. C. Mothers seen one-on-one in the lactation clinic after discharge are further encouraged to continue skin-to-skin care in the first weeks. Cocoa Beach. An evidence-based practice protocol for placing newborns skin-toskin at birth and in the immediate postpartum period was incorporated into our labor. a Baby-Friendly facility since June 2000. FL Tracy Lott. Health First Cape Canaveral Hospital. launched a skin-to-skin initiative in 2009.Dohnalek. indicative of a positive trend in the number of mother–baby couplets opting for this practice and verbalizing their intent to continue skin-to-skin care at home. The following outlines our transition from scheduled feedings to cue-based feedings. warmer babies. BSN. fathers and grandmothers. Reeg.g. with close attention paid to the infant’s developmental cues to decrease stress. BSN. Many NICUs still used a scheduled feeding method to initiate and progress oral feedings. Dallas. Results show a 90% success rate. Families were encouraged to attempt to keep their newborn skin-to-skin for up to 6 hours a day for the first week of life and a minimum of 2 hours a day for the second week through fourth week. O. Outcomes. and greater breastfeeding success. The staff at Cape Canaveral Hospital has observed anecdotal evidence of these benefits. can engage in the skin-to-skin care with the infant. Patient education pamphlets were distributed to women in labor and Kangaroo care shirts were loaned to new mothers during their hospital stay. Health First Cape Canaveral Hospital. IBCLC. delivery. Staff nurses were educated in appropriate skin-toskin techniques and patient instruction. Starrels. C. making allowance for individual circumstances and infant condition.. which has more than 200 nurses and staff. RNC. for the mother. Cue-Based Feeding: Implementation in an 83 Bed. decreased apnea and bradycardia. Inc. e. improved mother–infant interaction. RNC. The nursing and lactation staff at Cape Canaveral Hospital strive to achieve skin-to-skin care with every new mother–baby couplet. Cape Canaveral Hospital. L. Ad- ditional positive effects on neonatal self-regulation during the transition from intrauterine to extrauterine life include increased sleep. increased milk production. 41. may help JOGNN 2012. accelerated weight gain. T Proposed Change To implement skin-to-skin care in a baby friendly community hospital. This was S41 . Cocoa Beach. FL Keywords breastfeeding skin-to-skin care kangaroo care newborn Newborn Care Poster Presentation Purpose for the Program o improve mother–infant attachment and breastfeeding. level three. T Proposed Change Achievement of full oral feedings is often times the last milestone reached prior to discharge from the NICU. Implementation. MSN. Implementation.. Outcomes. and. Heer. Metropolitan Neonatal Intensive Care Unit Lindsay Newland.. Supplement 1 the NICU infant achieve full oral feedings up to 6 days sooner than a scheduled feeding method. Ryan. also known as an infant-driven approach. recovery. L. Vol. and Evaluation We introduced a cue-based feeding program in our 83-bed. MS. We at Cape Canaveral Hospital are committed to continuing promotion of skin-to-skin care as part of best practice. M. RNC-OB. updates in the unit newsletter.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.x Nora C.awhonn. plementation have been positive. Heightened awareness of the effects of noise in the NICU promotes an optimal environment for positive developmental outcomes. RN. anesthesia. Education included presentations in unit meetings as well as poster presentations. Dover. Specific noise-reduction strategies were proposed by the clinical excellence committee and agreed upon by the staff. how to read infant cues. bonding difficulties.1111/j. BSN. The education ranged in topics. JOGNN. we felt that changes needed to be made. After implementation. BSN. a nursing policy and guideline. Our clinical excellence committee wanted to explore the noise levels in our neonatal intensive care unit (NICU). Education was given in the form of bedside in-services. Our findings were that our levels exceeded recommended levels. including one team leader and four super-trainers on each shift. Columbus. such as benefits of cue-based feeding. Fortin. bedside charts were audited to assess staff adherence with cue-based feeding and address issues. Implementation. Concerns and common issues were addressed in the form of bedside in-services. Implications for Nursing Practice Cue-based feeding has become a common language in our unit and is considered a success. A multidisciplinary meeting took place 6 months after implementation to address concerns and update the program. RNC-NIC. as well as focus groups on each shift. Keywords skin-to-skin Implementation. and unsuccessful breastfeeding. Based on these findings. NH Newborn Care Poster Presentation http://jognn. and Evaluation patient satisfaction Informal surveys of patient satisfaction since im. S1-S118. and obstetrics. and a continuing education offering. Staff education was given by nurses. Columbus. Notestine. and Evaluation Our clinical excellence committee presented education on the effects of excess noise with the sup- port of the hospital leadership. OH Teresa L. Jennifer L. Rapp. Women giving birth by cesarean are more prone to postpartum depression. we developed a plan to provide skin-to-skin contact immediately after cesarean births. A S42 surgical environment and the delivery room and required collaboration between the departments of surgical services. 41. Newborn Care Poster Presentation Exploring New Frontiers: Providing Skin-to-Skin Contact for Mothers and Newborns during Cesarean Birth Purpose for the Program s cesarean birth rates increased in the United States in response to the American College of Obstetricians and Gynecologists’ statement concerning vaginal birth after cesarean. 2012. studies demonstrated higher dissatisfaction with childbirth experiences.org . Research is currently underway in our unit to assess time to full oral feedings and the effect on direct breastfeeding rates. M Proposed Change We provided education on the effects of excess noise on neonates to our NICU staff and implemented noise-reduction strategies in an attempt to decrease our overall noise level. and trouble shooting. and bring about complications in the medical management of the neonate. DOI: 10. Strategies were implemented by the staff and follow-up monitoring was completed to assess effectiveness. updates in emails and newsletters. questions and answers. educating parents.neonatal thermoregulation Proposed Change To increase maternal delivery satisfaction.2012. The proposed change broke the barriers between the traditional Implications for Nursing Practice This new service is an example of how nurses are empowered to question tradition to advocate for their patients. A more formal evaluation of the process will include a review of newborn thermoregulation in the operating room and a postpartum survey of patient satisfaction. Future research to consider is the effect that cue-based feedings has on oral aversion after discharge. Mount Carmel East Hospital. NNP-BC.1552-6909. Be Quiet! You Are Getting On My Neurons! Noise Reduction in the Neonatal Intensive Care Unit Purpose for the Program ultiple studies have shown that excessive noise affects neurodevelopment in infants. how to use a cue-based feeding scale form. can cause agitation. Outcomes. pediatrics. OH 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 environmental noise can be a major source of stressful stimulation. Outcomes. Mount Carmel East Hospital. Wentworth Douglass Hospital.01360. Outcomes. we project an increase in mom’s own milk. the number of admissions to the NICU has decreased for this population. and fiscal expenditures spent on donor milk. Baptist Health. the admissions had decreased to 9%. which benefits the mother. This process increases the nursing staff’s satisfaction about the care they provide. number of donor milk bottles used each day. Purpose for the Program RNC-OB. Working together with our medical. NICU. Implementation. Proposed Change The MOM Bundle uses quality initiatives throughout the Women and Children’s Service line to initiate and maintain the mother’s milk supply. Having the infant in close proximity increases the time available for educating the mother about the unique needs of the special care infant and allows her to feel an increased sense of confidence when taking the infant home. Christina Conner. Neonatal Intensive Care Unit E. It was decided that the differing needs of these infants from full-term newborns could be provided for in a virtual setting. Vol. our goal is projected to decrease donor milk use. which both recognize the protection and value of mom’s own milk. Each year since implementation. 41. The purpose of the Mom’s Own Milk (MOM) Bundle is a multidisciplinary. Purpose for the Program IBCLC. The JOGNN 2012. and NICU support staff. baseline breastfeeding rates. AR Keywords special care length of stay late preterm infant Newborn Care Poster Presentation T ery is to decrease the length of stay for these patients while maintaining quality care. After looking at the average length of stay. and Evaluation Over a 6-month timeframe. information was gathered. The average length of stay for the special care infant was 7 days. Level III.I N N O VAT I V E P R O G R A M S Fortin. TX H Keywords breast milk NICU quality initiatives collaborative increasing milk supply Newborn Care Poster Presentation tiatives. Little he purpose of the virtual special care nursRock. such as The Joint Commission Perinatal Core Measures and Baby Friendly Hospital Initiative. and a plan was implemented to care for the special care infant on the postpartum unit. Outcomes. N. The use of human donor milk in the neonatal intensive care unit (NICU) has been expensive but worth the payoff with less very low birth weight morbidity and mortality in our large NICU. BSN. decrease medical and surgical necrotizing enterocolitis rates. Implementation. approximately 75% of late preterm infants were admitted to the NICU prior to the implementation of the special care nursery. Implications for Nursing Practice The MOM Bundle is a collaborative approach to increase the availability and volume of mothers’ milk in our Level III. Supplement 1 team estimated that within 24 hours after birth. S43 . collaborative approach to gently encourage and support a mother’s decision to provide her precious milk for her baby in the NICU. and decrease length of stay. 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. The care would be provided in the mother’s room or the well-baby nursery. Proposed Change A majority of infants born 35 to 36 6/7 weeks of gestation and infants born to mothers who were diabetic and insulin-dependent were admitted to the neonatal intensive care unit (NICU) for monitoring within 24 hours of birth. C. This allows for the infant to remain with the family. McFail. Improvements are focused on the barriers mothers face when providing milk and discovering an innovative game plan to reduce those barriers. nursing. Baylor University ospitals are encouraged to step up Medical Center at Dallas. 83-bed. Proceedings of the 2012 AWHONN Convention Mom’s Own Milk Bundle: Increasing Supply in an 83 Bed. After 6 months of implementation. protocols established. the infant. and Evaluation Implementation of this quality initiative focuses on staff and family education. Nurses would be trained following evidence-based guidelines. evidence-based practices with various iniDallas. Virtual Special Care Nursery: A Cost Savings Idea Michelle M. equipment purchased. and the hospital goals. RN. MSN. RN. the decision was made to provide further patient follow-up. We sought to identify infants at risk and streamline the evaluation and treatment process by instituting a weekend and holiday Bili Clinic on the mother-baby unit. psychosocial. E Martha Montes.2012. Chicago. P S44 Proposed Change The University of Minnesota Amplatz Children’s Hospital’s Perinatal Palliative Care is a familycentered. we instituted collection of cord blood type and Coombs testing at delivery for mothers with blood type O positive or RH negative blood types. bin test performed and if the result was greater than 6 a serum bilirubin specimen was collected. discharge home. Parents received an information form with the follow-up appointment to the Bili Clinic (scheduled anytime from 8:00 a. BSN. the staff activated the Bili Clinic process. Infants received phototherapy in a timelier manner and thus increased patient and nurse satisfaction. parents are supported in creating a plan of care for their baby that is consistent with their goals and wishes. RN. and Evaluation To identify infants at risk. Proposed Change Previously. The weekend and holiday Bili Clinic opened in April 2010. treatment options with second opinions or withdrawal of life sustaining measures. and promoted better outcomes for the patient. or admit the newborn for treatment. University of Minnesota Medical Center. Minneapolis.x Becky Gams. to 4:00 p. BSN. Implementation. MS. The goal was to identify those at risk of hyperbilirubinemia and initiate treatment in a timely manner. As parents arrived for followup. JOGNN. University of Illinois Medical Center. birth. CNP. MN Keywords comfort care palliative loss newborn life-limiting fetal Newborn Care Poster Presentation http://jognn. 2012.1552-6909. This process for at-risk infants bypassed the emergency department and facilitated prompt treatment at the Bili Clinic. Based on the test results. newborn health care providers (from the departments of pediatrics or family medicine) identified newborns requiring outpatient follow-up on the weekend and holiday and initiated the process for pre-admission to the Bili Clinic. Most infants with hyperbilirubinemia who are discharged before 72 hours should be seen within 2 days of discharge. comfort care or pursue neonatal intensive care intervention. The American of Academy of Pediatrics has instituted guidelines for the assessment and management of hyperbilirubinemia in newborns. notified the newborn health care provider of the newborn’s arrival. transcutaneous bilirubin. which delayed evaluation and treatment. Chicago. S1-S118. The purpose of this project was to develop an innovative approach to identify newborns at risk of hyperbilirubinemia at delivery and at 24 hours of life and to improve neonatal outcomes for at-risk infants with hyperbilirubinemia after discharge during the weekend and holiday. pregnancy. all newborns after 24 hours of life had a transcutaneous biliru- Implications for Nursing Practice Evaluation is ongoing based on patient comments and efficiency of workflow for nursing staff. or serum bilirubin) as requested.01360.m. decreased overall costs. and death. 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. and spiritual support through diagnosis. maintained a logbook. Fairview. IL Keywords hyperbilirubinemia phototherapy transcutaneous bilirubin (Tcb) Bili clinic Newborn Care Poster Presentation Operationalizing Palliative Care Processes through a Perinatal Palliative Care Program Purpose for the Program arents who receive a life-limiting fetal diagnosis face many unexpected decisions: continue the pregnancy or proceed with early termination. Outcomes. Throughout this process. The program goals address the National Quality Forum’s Preferred Practices for Palliative Care and support caregivers in meeting palliative care outcomes. IL Lourdes Notario.org . discharged infants with hyperbilirubinemia who required follow-up on weekends and holidays were seen in the emergency room.m. multidisciplinary program that provides a continuum of medical. 41.awhonn. and initiated procedures (weight. emotional.1111/j. DOI: 10.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Two Phase Innovative Approach for Newborns at Risk of Hyperbilirubinemia Purpose for the Program ach year approximately 60% of the 4 million newborns in the United States receive a diagnosis of clinical jaundice. and informed parents of required follow-up. During the week. Furthermore.). University of Illinois Medical Center. RN. Implications for Nursing Practice Nurses have implemented a low-cost intervention that decreases length of stay and. affects hospital finances and provides quality patient care to a vulnerable population. thus. the average length of stay for infants with NAS was 22. B.855 hours of cuddling to patients suffering from NAS. Baby cuddlers on a daily basis held. and Evaluation Seventy-five infants were admitted to the department with the diagnosis of NAS in the 1-year study period from May 2009 to May 2010. and creation of a multidisciplinary education process. From initiation of the project on October 1. The importance of human contact and touch in the well being of all hospitalized infants has been well documented. Proceedings of the 2012 AWHONN Convention Implementation. Nurses conWestern Pennsylvania Hospital. a decrease in length of stay of 3. Outcomes. MS. 2011. Vol. RN-BC. Steps to formalize the program. However. After the official evidence-based project ended. eight families were served in 2011 (year-to-date). care conference documentation.9 days. care for these families was heroically pulled together by a few dedicated and passionate individuals.4 days. RN. PA T for neonatal abstinence syndrome (NAS) has in- Mona Patterson. and comforted the infants suffering from drug withdrawal. RN. interviews with leaders from established programs. The Western logic intervention is necessary and/or effective. from May 2010 to April 30. the needs for families choosing to continue pregnancy and newborn comfort care were expected to grow as well. The length of stay average was 23. Supplement 1 Implementation. Pennsylvania Hospital. The cuddler provides an important component of the developmental care for the hospitalized infant. and process workflow will be displayed. JOGNN 2012. From November 2009 to May 2010. responsibilities for maternal and neonatal medical management. and Evaluation Historically. and multidisciplinary education will be described. The creased more than 150% since 2004. The purpose of the program. Baby Cuddlers Make a Difference Monica C. duct the Finnegan Neonatal Abstinence Scoring Pittsburgh. Purpose for the Program RNC-LRN.8 days. Families commented that “this was the happiest and saddest day of my life. included a literature review. Although current numbers are small. a broad health care team accommodates the individual needs and circumstances of each family in the program. From May 2009 to October 2009.3 days compared with the initial noncuddler group. The he number of newborn infants treated every Western Pennsylvania Hospital. S45 . the average length of stay for infants with NAS was 26. 2009. Program scope.” Data from patient satisfaction surveys and multidisciplinary debriefings are disseminated to the health care team. drawal symptoms and determine if pharmacoMSN. Within this supportive formalized structure. BSN. Baby cuddlers completed an orientation to their role and received education on hand washing and Health Insurance Portability and Accountability Act regulations. Implications for Nursing Practice The Perinatal Palliative Care program offers this care model within an institution with an established pregnancy and newborn loss program and a recently established Fetal Diagnostic and Treatment Center. the pediatric unit cared for an additional 75 NAS patients. a decrease in length of stay of 2. BSN. baby cuddlers have contributed 2. PA Keywords baby cuddler neonatal abstinence length of stay Newborn Care Poster Presentation medication.I N N O VAT I V E P R O G R A M S Gams. Kraynek. A detailed birth plan template. newborn comfort care orders. Proposed Change A baby cuddler is a trained baby holder who can fill the gaps when parents are not able to be present. as a unit evidencebased practice project. PA Tool every 2 hours to analyze the infant’s with- Christina Westbrook. as the newly established Fetal Diagnostic and Treatment Center’s patient volume grew. to February 28. role definitions. program access. MBA. Up to 30% of infants may be managed without Pittsburgh. 2011.2 days without the baby cuddler program. averaging four per year from 2008 to 2010. led by the advanced practice nurse leader. was to learn if the addition of baby cuddlers as caregivers could affect the length of stay required for treatment of these infants. rocked. Interventions for treatment of these infants include medication and supportive care. 41. year at the Western Pennsylvania Hospital Pittsburgh. development of support from hospital administration and key individuals willing to operationalize the program. 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. The palliative care approach is enhanced by our established Pregnancy and Newborn Loss program. Outcomes. act.1552-6909. high-risk transition newborns. are admitted to the NICU for up to 6 hours of observation. A Proposed Change To develop standards in clinical practice to promote newborn stabilization specific to newborns delivered between 35 and 36 weeks of gestation. JOGNN.org . Glucose management. Clinical autonomy was maintained for the NICU nurse who provided care to the newborn during the transitional time frame. Implications for Nursing Practice Clinical criteria to identify newborns at risk of instability during extrauterine transition of life were standardized and embedded into practice. full-term hypoglycemic newborn transfers decreased 15% from the mother–baby unit to the NICU. plan. MS. BSN. 2012. This offering will detail the pragmatic strategies utilized to decrease NICU admissions of high-risk transition newborns and present specific obstetric-related diagnoses. Implementation of bath delay showed that regardless of gestational age.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Normal Newborn Nursery – Neonatal Intensive Care Unit: What’s in Between? Purpose for the Program trend of term newborns requiring transfer from the newborn nursery to the neonatal intensive care unit (NICU) was identified in a Level III NICU at a Magnet hospital. Standard processes and care requirements enabled nurses in a NICU to make prudent and timely decisions to improve neonatal outcomes. born to mothers with chorioamnionitis or diabetes who received IV insulin during labor. RNC-NIC. A multidisciplinary approach was utilized to assure all care providers involved with maternal–newborn care received education. families were made aware of where their newborns would be admitted. 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. and newborn admission policies were revised to reflect new processes. born to mothers with chorioamnionitis or diabetes who received intravenous (IV) insulin during labor. the incidence of newborns experiencing hypothermia and hypoglycemia during the transitional period was reduced by changing the focus of unnecessary interventions. BA.x Diana V. The criteria and interventions were standardized and embedded into practice. PA Keywords transitional NICU transitional newborn nursery observational nursery Newborn Care Poster Presentation “Wait for Eight”: Improvement of Newborn Outcomes by the Implementation of Newborn Bath Delay Purpose for the Program o improve newborn outcomes by implementing the evidence-based research to delay bathing the newborn. 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. the newborn. BSN. which included the development of crib cards in order for clinical staff to facilitate the process change by direct hands-on education. FL Marcia K. T Proposed Change To improve newborn outcomes. Baycare/Saint Joseph’s Women’s Hospital. PA Denise Keeler. Outcomes. Tampa. These infants. Baycare/Saint Joseph’s Women’s Hospital. Lehigh Valley Health Network. Lehigh Valley Health Network. Allentown. S1-S118. and Evaluation To review the current practice and identify the prioritization of the nursing task over the outcomes of bathing. The criteria were communicated to the family prior to delivery to ensure inclusion with all aspects of care.01360. and Evaluation A collaborative team approach was taken to establish clinical criteria to identify infants at risk of transfer to the NICU.1111/j. and the transfer of all newborns back to the mother–baby unit is about 80%. 41. RN-C. Outcomes. To foster family-centered care. newborn care guidelines including revision of newborn order sets were established. including process flow charts. Nurses are critical to assess. and evaluate care for high-risk transition newborns to improve clinical outcomes and increase efficiency. Tampa. breastfeeding. Scripting to parents and families were created.2012. and reference cards. FL Keywords newborn bath delay skin-to-skin transition Newborn Care Poster Presentation http://jognn. the admission of high-risk transition newborns to the NICU increased 27%. Judith Pfeiffer. Reference to evidence-based research and data collection post-implementation of guidelines were utilized. algorithms. Lipka. Schulz. RNC.awhonn. Since July 2008. S46 Implementation. Standards were developed for newborns delivered between 35 and 36 weeks gestation. Multidisciplinary team actions involved evidence-based practice data regarding the effectiveness of newborn bath delay. DOI: 10. RNC. implementation of evidence-based research was initiated. Allentown. Implementation. and optimize brain growth and visual development. which promotes feeding tolerance. carbohydrates.I N N O VAT I V E P R O G R A M S Lipka. RN. and Schulz. including necrotizing enteral colitis and nosocomial infections. To improve newborn outcomes. S47 . longitudinal data are being collected on the infant outcomes posttreatment. The value of skin-to-skin care with transition. implementation of evidence-based research was initiated to foster practice change. 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. and developmental properties that prevent infection. 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. M. This population of patients in the neonatal intensive care unit (NICU) is most vulnerable to morbidities. Proposed Change The nursing intervention of buccal application of a mother’s colostrum potentially decreases the incidence of certain morbidities and decreases the length of stay of these fragile infants. We created syringe kits with detailed instructions for the collection of a mother’s breast milk to avoid waste. Mission here is overwhelming evidence in the literature Hospital System. Outcomes. Our efforts were validated by the improved outcomes of practice change of newborn bath delay. Supplement 1 posed change in practice is to institute a policy of buccal application of colostrum in the NICU. and breastfeeding was emphasized. mothers are being encouraged to begin pumping within 6 hours of delivery and pump on a prescribed schedule. the incidence of newborns experiencing hypothermia and hypoglycemia during the transitional period was reduced by changing the focus of unnecessary interventions. Human milk decreases the incidence and severity of nosocomial infections and necrotizing enteral colitis. IBCLC. It contains immunological. The purpose of this project is to promote buccal application of mother’s colostrum for low birth weight infants in the NICU. Recognition of the importance of an uninterrupted newborn transition resulted in positive newborn outcomes and patient satisfaction. Implications for Nursing Practice Historical review of newborn care delivery demonstrated that nursing has shown to place priority on the completion of nursing tasks over the outcomes related to the newborn transitional period. The research of skin-toskin practice directly correlated the need to review newborn care and practices thereof. NC T Jennifer Wilkinson. Mission Hospital System. nutritional. Buccal Care with Colostrum in the Low Birth Weight Infant Kimberly Pinkerton.500 grams) was developed and implemented in January 2011. BSN. The infants are being followed longitudinally for outcomes related to this care. 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. Implications for Nursing Practice Due to the limited availability of colostrum. K. It also has been proven to protect against gastrointestinal and respiratory infections. RNC-NIC. MSN. Staff education was completed at staff meetings via slide presentations. Ongoing education of staff and parents is imperative to the successful implementation of this policy. The completed policy also includes an education sheet for parents as a means of encouraging their participation in this bedside practice. Global hospital staff education was initiated and staff were presented with advice to give to parents and families during newborn care education. D. provide individualized nutrition. Implementation. Vol. which resulted in increased patient satisfaction. NC Keywords low birth weight babies breast milk NICU buccal care Newborn Care Poster Presentation that human milk is superior to any form of nutrition for the neonate. and plasma proteins improves gastric emptying. The pro- JOGNN 2012. Implementation of bath delay showed that regardless of gestational age. Purpose for the Program RNC-NIC. Asheville. Asheville. V. The need to review one such practice was the newborn bath. 41. Currently. Its perfect combination of protein. Proceedings of the 2012 AWHONN Convention The description of the process from admission to discharge identified the value in bath delay related to skin-to-skin research. bonding. At the time of this abstract submission. Picture-based patient education was developed and posted in patient rooms for easy access by patients and visitors. ARNP-BC. CA Monika Lanciers. DOI: 10. consideration should be given to utilizing pictures in addition to text. C Proposed Change A comprehensive program was developed. T Implementation. Three falls occurred in 2010 prior to the implementation of staff and patient education. Joseph’s Women’s Hospital’s NICU began reviewing central line care and the current literature concerning best practices for central line management. there were no falls for nearly a year. and (i) development of a standardized sterilized PICC dressing change kit.x http://jognn. 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. In 2009.awhonn. is effective in significantly reducing CLABSI in the NICU. CLABSI rates in the NICU decreased progressively from 10.000-catheter days by the end of the year. random audits. and in 2010 there were Ellen Fleischman. (d) competency validation for all staff performing central line blood sampling. Outcomes.43 falls per 10. FL Keywords central line associated blood stream infections quality champion central line bundle hand hygiene random audit neonatal intensive care unit Newborn Care Poster Presentation Implications for Nursing Practice A comprehensive program of central line management.1111/j. and gathering surveillance data for quality improvement.000-catheter days just before the initiative begun in June 2009 to 5. JOGNN. however. CA Keywords falls of infants health literacy cultural barriers staff education Newborn Care Poster Presentation Reducing Catheter Associated Bloodstream Infections in the Neonatal Intensive Care Unit: Challenging Nurses to Be Champions Purpose for the Program entral line-associated bloodstream infections (CLABSI) are associated with increased mortality and adverse outcomes in multiple systems in the neonatal intensive care unit (NICU) patient. there were 5. Jayne Solomon. a designated committee at St. This role includes overseeing and participating in staff education. In June 2009.568 live births in 2010). RN.5 falls per 10. Implementation. The number of bloodstream infections decreased from 30 in 2009 to 10 in 2010.1552-6909. and Evaluation Focused staff and patient education were implemented in April 2010. S1-S118. and a timeline was established to implement multiple interventions into the unit’s guidelines for the management of central lines. The patient education posters were translated into Spanish. MBA. Tampa.000 live births (4. and Evaluation Strategies included the following: (a) hand hygiene. From the implementation of education. Joseph’s Women’s Hospital. RN. The CLABSI rate for 2010 was 3.83 falls per 10. Staff and patient education were developed utilizing the findings from incident reports. (c) validation for a team of nurses to perform peripherally inserted central catheter (PICC) inser- S48 tion and dressing changes. patients at Sharp Mary Birch Hospital for Women & Newborns originate from a variety of countries and speak many different languages.37 per 1000-catheter days.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Don’t Drop That Baby! Purpose for the Program he purpose of this poster is to share information regarding the incidence of falls of infants.341 live births as of June. The designation of a quality champion who is responsible for the initiative is vital to the success of this program. Proposed Change Investigations were completed to identify trends in the falls of infants.01360.17 per 1.000 live births. the education strategies employed to decrease the risk of falls.org . (h) random audits. To optimize comprehension of patient education. 2011). Outcomes. Sharp Mary Birch Hospital for Women & Newborns. led by a quality champion. 2012. Sharp Mary Birch Hospital for Women & Newborns. a 67% decline.2012. (e) standardized central line tubing change policy. (f) daily audits of all central lines for integrity and necessity. CLABSI can be significantly reduced and in some cases completely eliminated.000 live births (8. St. Implications for Nursing Practice The success of patient education may be attributed to the goal of educating the patients and visitors as well as providing education to illiterate or non-English speaking patients. there were 0. (g) “scrub the hub” care.84 per 1. San Diego. 2. MSN. BSN. RD. 41. motivating and communicating with the team. (b) development and implementation of central line insertion and maintenance bundles. San Diego. All of the literature in the past 2 years regarding CLABSI has shown that with the implementation of evidence-based strategies. Supplement 1 Proposed Change The Close to Me intervention includes parent education and awareness materials. Strategies were developed to hardwire the process and facilitate a change in practice that supported the use of Kangaroo care. to 74% in July 2011. RNC. KY Susanna Bowen. BSN. and items of comfort and encouragement for families. as a way to keep infants warm and provide optimal nutrition following birth. Staff respondents also reported the benefits of Kangaroo care include reduced stress. Our journey continues with further education and improved practices. The American Academy of Pediatrics recommends skin-to-skin contact as a strategy to increase breastfeeding success. began in 1979 in Bogota. JOGNN 2012. LMSW. accurate data collection and a comprehensive educational program are vital to support the initiative. Vol.I N N O VAT I V E P R O G R A M S Bagby. White he national evaluation results of the March Plains. or skin-to-skin contact. March Purpose for the Program of Dimes Foundation. PCE. Implementation. It is essential that all levels of leadership support and monitor standard of care practice at the bedside. but only 8% of staff reported routinely offering Kangaroo care to families. PCE. During this time the percentage of eligible infants who were placed in Kangaroo care at birth increased from 60% to 73%. BSN. Implications for Nursing Practice Implementation of the Kangaroo care initiative improved breastfeeding rates in the population served by the ULH. the philosophy was not adopted as a standard of care until 2010. a national evaluation of Close to Me was conducted in four NICU sites using an outside consultant who conducted staff focus groups and surveys preintervention and postintervention. Proceedings of the 2012 AWHONN Convention Kangaroo Care Increases Breastfeeding Rates Kim Bagby. K. enhanced comfort. and increased parent–infant bonding. including increased breast milk supply and greater breastfeeding success. 41. policies were revised. The Perfect Pouch: A March of Dimes Intervention to Enhance Onset and Frequency of Kangaroo Care Liza G. also three staff members received certification in Kangaroo care. Implementation. and Evaluation Current literature was examined. Research has shown that Kangaroo care has many benefits for mothers and infants. Louisville. Staff accountability is crucial to any successful change in practice. University of Louisville Hospital. and Evaluation Close to Me was unveiled in March of Dimes R program sites nationwide. and staff expectations for participation were established. and Bowen. S. Breastfeeding initiation rates increased from 51% in July 2010. University of Louisville Hospital. KY Keywords kangaroo care skin-to-skin contact breastfeeding barriers to kangaroo care Newborn Care Poster Presentation Purpose for the Program or eligible mother–infant dyads. Columbia. NICU Family Support In 2011. Outcomes. S49 . NY Keywords Kangaroo Care skin-to-skin staff resistance parent awareness Newborn Care Poster Presentation T of Dimes NICU Family Support program revealed that neonatal intensive care unit (NICU) parents felt that the most comforting activity that could be offered in the NICU would be to hold their infants. Cooper. staff education materials. a Kangaroo care program for healthy infants and their mothers at the University of Louisville Hospital (ULH) was implemented. 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. Outcomes. In 2007. However. 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. Breastfeeding and Kangaroo care progress was shared monthly with staff. The percentage of mothers and infants documented as participating in Kangaroo care in the mother–baby unit also increased from 35% to 51%. This quality initiative is being shared with 57 birthing hospitals throughout Kentucky. Louisville. The March of Dimes developed the Close to Me intervention to increase the early onset and frequency of Kangaroo care in NICUs. RN. In addition. does implementation of Kangaroo care at birth increase breastfeeding rates compared to retrospective breastfeeding rates? F Proposed Change Kangaroo care. Kangaroo care champions were identified and assisted other staff with completion of Kangaroo care competencies. Documentation was improved to facilitate accurate data collection. The physiological. including fullterm babies and those in the NICU for a short stay. These data were presented to the 2009 California Perinatal Quality Control Collaborative annual meeting in Sacramento and at the hospital-wide infection control committee. Parents can learn to ask for and advocate for this activity if they know about it and its benefits early in their baby’s hospitalization. Key findings from this work also will be discussed. the infection rate was reduced by 58% and audit data showed adherence to be at 96% and greater. RNC-NIC.x http://jognn. S1-S118. the staff members were educated through the creation of a six-panel poster session on the policy. and pertinent information was added to the policy and procedure. and hands-on instruction. each policy concerning infection control was reviewed. 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. Kangaroo care can be vital to many if not all babies in the NICU. Del Mar. A New Look At Infection Control in the Neonatal Intensive Care Unit Purpose for the Program o reduce infection rates in the neonatal intensive care unit (NICU) by 30%.2012. which holds parents to the same standards as the nurses and doctors. Implications for Nursing Practice Kangaroo care is a proven benefit to newborns and parents. This project was started in July 2008 after the unit joined the California Children’s Quality Initiative in January 2008. 41. and providing continuing education to new and current staff.1111/j. the last 5 years of peer-reviewed literature on infection control pertaining to neonatal intensive care was reviewed. well-baby audiences of professionals and parents. specific audit tools were used to assess staff adherence to the components of the policy. the aim of this project was to recreate the policy and procedure on infection control for the NICU.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention parent surveys. Staff resistance to its implementation can be overcome with awareness. and a special parent journaling technique. the policy was reviewed and ap- S50 proved by the medical director and delivered to Michele L.01360. and each multidisciplinary group in the NICU was met with (for example the peripherally inserted central catheter team). We are accomplishing this by reviewing current evidence-based practice yearly and changing practice accordingly. T Proposed Change To educate and implement policy to reduce the NICU infection rates. Finally. continuing to complete audits on practice.1552-6909. medical. During this time. Researching Kangaroo care by having parents maintain a journal is appealing to parents who have the opportunity to heal and process as they participate in the study. The initial goal for 2008 was to reduce infection rates in the NICU by at least 30%. Also. These teams compiled input. DOI: 10. and Evaluation To change the way we look at preventing infections in the NICU. This project was completed as follows: the California Children’s Quality Initiative guidelines were collected and incorporated into the current infection control policy for the unit. We worked closely with a large team of NICU staff on adapting our materials for the full-term NICU infants and the full-term. 2012. Center. UCSD Medical the core group for the unit. Each staff member was required to walk through the poster session and answer a set of competency questions that pertained to the poster session. Carson. CA Once the policy was finished. MSN-CNL. The policy was approved by the hospital-wide infection control committee and is under review for adoption on other hospital units. Outcomes. education. Keywords NICU CLABSI quality initiative Newborn Care Poster Presentation Implications for Nursing Practice At this time our efforts are focused on sustaining the gains. Implementation. Overall.awhonn. a parent agreement was created that centered on infection control. and the information was added as appropriate to the policy. and emotional benefits of Kangaroo care are worth the additional time required in educating staff and providing comforting space and opportunities for parents to Kangaroo care their infants. JOGNN.org . Fort Worth. Our staff would then be educated on the changes. to educate families on safe sleeping arrangement. RN. TX Keywords education newborn safety sheet snuggle time hourly rounding Newborn Care Poster Presentation Purpose for the Program n the first 2 years that Andrews Women’s Hospital was open. Baylor All Saints Medical Center. CLC. In addition. Implications for Nursing Practice Education of families and hourly rounding are absolutely necessary for keeping our infants safe. TN Newborn Care Poster Presentation B Proposed Change Our plan was to increase the support and duration of exclusive breast milk feeding by placing infants skin-to-skin during the immediate post delivery period. We began placing all breastfeed- JOGNN 2012. Bristol Regional Medical Center. Second. we emphasized with the newborn nursery staff and postpartum staff how important it was to make sure that the mother has the call bell within reach. Tessa Brown. we educated both the newborn nursery and the postpartum staff on the need to hardwire the hourly rounding on all shifts. the postpartum registered nurse (RN) would alert the RN nurse when the mother had taken pain medication. We then looked at how we could support the use of breast pumps for our patient population. BSN. recommending exclusive breast milk feeding during Keywords an infant’s entire hospital stay. we began to encourage early pumping for infants that were not feeding well at the breast or were unable to be at the breast because of medical conditions. Second. BSN. We began an extensive campaign to make sure that the mothers understood the adverse effects of pain medication. Supplement 1 ing infants skin-to-skin within the first hour and allowed them to self-attach to the breast for the first feeding. Vol. we educated our nursing staff on the importance of supporting breastfeeding. Combining these interventions has a great potential to increase the rates of exclusive breast milk feeding during the hospital stay and beyond. we initiated “snuggle time” every day from 2:00 to 4:00 to promote maternal rest without interruptions. we were able to provide the early intervention and support necessary for our patient population. Proceedings of the 2012 AWHONN Convention What Do You Mean You Dropped Your Baby? Changing and Hardwiring Nursing Practice to Eliminate Infant Falls Linda Woodson. Finally. Our goal was to inskin to skin early pumping crease the rates of breast milk feeding during the exclusive breast milk feeding duration of the hospital stay and the rates of infants easy access for rental supplies who were exclusively fed breast milk at discharge to promote what is best for infants and comply with the the Joint Commission’s recommendation. The outcome has been very positive. Implications for Nursing Practice By implementing these changes. Next. and Evaluation We implemented the project by first using a tally sheet to identify common trends that occurred in the falls of newborns. we experienced eight infant falls. RN. 41. The proposed changes were to hardwire hourly rounding on all shifts. we planned to begin encouraging early pumping for mothers of infants that were not breastfeeding well or were unable to nurse. TN Joint Commission recently introduced PC-05. Then.I N N O VAT I V E P R O G R A M S Woodson. Our partnership with the pharmacy has allowed our patients easy access to breast pump rentals and supplies. In addition. In addition. We then planned to make breast pumps and supplies more readily available for our patients. Outcomes. which has been shown to increase the success of breastfeeding by approximately 80%. and Evaluation Our unit began implementing changes to support the breastfeeding relationship in the above mentioned areas. Outcomes. and it has been 1 year since the last fall of a newborn occurred. S51 . Supporting Breastfeeding in the Hospital: A Better Start Purpose for the Program reast milk feeding is the best option for infants and exclusive breast milk feeding is Maggie Redmon. Finally. Bristol. even when she is placed in a chair. we developed a newborn safety sheet that described the elements of safe sleeping and re- quired that both the mother and the significant other sign the sheet because three infants had been dropped by fathers. L. the Center. and to promote maternal rest. Patients are excited about the skin-to-skin process and our early support and intervention. 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.Andrews Women’s Hospital. C-EFM. Bristol. Implementation. RN. Implementation. supported by the American Academy of PediBristol Regional Medical atrics for the first 6 months of life. I Proposed Change Our goal was to eliminate infant falls at Andrews Women’s Hospital. allowing them to become breastfeeding advocates for our patients. and supports the Association of Women’s Health. and the director of women’s services. Milford. Because of the sensitive nature of drug testing and possible legal ramifications. RNC-OB. Outcomes. R Proposed Change Meconium drug screening is considered the gold standard for drug testing in the neonate. accuracy in patient test results is crucial. and Breastfeeding in the Post-anesthesia Care Unit” enhances overall postpartum operative care. FNP-BC. TN Keywords drug testing substance abuse umbilical cord testing neonatal abstinence scoring Newborn Care Poster Presentation http://jognn. Increase in false positive test results lead to questioning the truthfulness of the test. however. Decline of the Gold Standard! Umbilical Cord Tissue Provides Timely and Accurate Results to Enhance Quality Outcomes for the Neonate Purpose for the Program ecent literature reviews stated that approximately 5% to 10% of women self-report the use of illicit drugs during pregnancy. This team was formed to change the policies and procedures to allow infants to remain with their mothers after a cesarean birth and the immediate postpartum surgical recovery period. postanesthesia recovery team members. Because of the sensitive nature of this test. fosters teamwork between nursing units.1552-6909. A process was developed to assist with the implementation of the new procedures and to educate and direct nursing teams involved with cesarean births. The goal was to identify a process that provided ease of obtaining specimen sampling and accurate patient test results. 2012. Milford Memorial Hospital-Bayhealth. Johnson City. Implementation. DE Keywords babies bonding breastfeeding PACU Newborn Care Poster Presentation Implications for Nursing Practice Implementing “Babies.I N N O VAT I V E P R O G R A M S Proceedings of the 2012 AWHONN Convention Babies.1111/j. The advantages of this process included samples being sent immediately after birth. mothers and infants are separated quickly after cesarean birth and not reunited until hours later.2012. MSN. Lauren Griffin-Walls. newborns are placed naked on their mothers’ chests immediately after birth. our obstetric nurses created a seamless process to keep the mother and infant together throughout the challenging postoperative period. Obstetric and Neonatal Nurses’ commitment to positive perinatal outcomes. the roles and responsibilities of the labor and delivery 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. and supported thermal regulation of the newborn. promoted early breastfeeding. enhanced quality of care. In most community hospitals.org . In collaboration with our post-anesthesia recovery team. Evaluation revealed that keeping the mother and baby together after cesarean birth increased patient satisfaction.x Tanyelle Bellamy. Facilities should establish their own testing protocols and unbiased guidelines to identify when testing should occur because the literature does not indicate consensus on universal screening. The proposed change was to implement umbilical cord tissue screening. a chain of custody JOGNN.01360. lactation consultants. RN-CPN. RNC. allowed skin-to-skin contact. and Evaluation A multidisciplinary team was formed that consisted of labor and delivery nurses. I Proposed Change In an effort to provide immediate skin-to-skin contact and allow for early breastfeeding for mothers and their healthy infants after operative deliveries. but be- S52 cause of false positive test results and the length of time to obtain confirmatory results it was identified that a practice change was necessary. A positive maternal test result determines the initiation of the protocol to test newborns. BSN. Evidencebased best practice was used to guide staff education.awhonn. Milford Memorial Hospital-Bayhealth. DOI: 10. Milford. Mountain States Health Alliance. Bonding. which is viewed by many as necessary for the infants’ survival. and a chain of custody. The education incorporated the importance of skin-to-skin contact between the mother and baby and early breastfeeding after an operative delivery. 41. S1-S118. receiving only confirmatory results. DE Jaclyn Lewis. Bonding and Breastfeeding in the Post-Anesthesia Care Unit: Innovative Family Centered Care in a Community Hospital Purpose for the Program n many cultures. universal testing in high-risk populations indicates higher rates of illicit drug use. Outcomes. Nursing leadership met with pathology and lab directors to discuss switching the testing location from a local laboratory to sending the tests to an outside reference lab. EdS. parent. Proposed Change By enhancing parent confidence and competence. Proceedings of the 2012 AWHONN Convention was seen as a necessary piece of our process improvement. his community-based program is designed Boca Raton. Outcomes. in the immediate postpartum period. Implementation. The outcomes focused on increasing result turnaround times. emergency resources visits. JOGNN 2012. obstetric. Lakewood. Purpose for the Program RN. including assessment. Making Kangaroo Care the Norm: Implementation of a New Model of Care Lynn Barabach. which was developed in collaboration between the departments of nursing and neonatology. Supplement 1 Implementation. and Evaluation The plan was discussed and approved by the neonatologists and pediatricians. Proposed Change Our goal was that all appropriate infants would be placed in Kangaroo care shortly after birth and would remain with their mother or the mother’s support person for 60 to 90 minutes. FL Keywords NICU discharge simulation caregiver competence Newborn Care Poster Presentation T to enhance parents’ competence and confidence as caregivers after their infants’ discharge from the neonatal intensive care unit (NICU). the Lakewood Hospital Birthing CenOH Joy Sedlock. and breastfeeding classes. MSN. Walden University. ANEF.I N N O VAT I V E P R O G R A M S Bellamy. The program also has the potential to decrease the use of health care resources. OH Keywords kangaroo care infant childbirth breastfeeding Newborn Care Poster Presentation I ter embarked on the journey to obtain BabyFriendly. T. OH Kate Salmon. Purpose for the Program Lakewood Hospital. and Evaluation Nursing leadership worked with a nationally recognized expert on Kangaroo care to provide education to the nurses. Kangaroo care also is discussed during tours of the Birthing Center. Implications for Nursing Practice The use of high-fidelity simulators may have a significant role in the process of discharge teaching in the NICU. USA designation. MSN. It was identified that a key component for a successful journey was the implementation of Kangaroo care. or skin-toskin care. Lakewood Hospital. IBCLC. To date. The program accepts referrals from all the NICUs in the county and from the Health Department. potentially decreasing the newborn’s length of stay. Vol. Implications for Nursing Practice The implications for the nursing practice included the need for a standardized order set for newborns experiencing neonatal abstinence symptoms. Lakewood. RNC. and Evaluation The program is conducted in the department for caregiver education and uses a preemie high-fidelity simulator. All nursing staff received in-service on neonatal abstinence scoring to help staff provide more consistent and accurate scores. The time in Kangaroo care with the mother would facilitate transition to extrauterine life and allow the infant to self-latch at the breast. A 4-hour program on Kangaroo care was developed and included discussion of the benefits. CNM. and decreasing rates of false positive test results. Initial implementation began at a regional tertiary care facility and a smaller community hospital where the largest volumes of maternal substance abuse were experienced. Outcomes. and ongoing care of the infant. 41. n 2009. Placing the infant in Kangaroo care was demonstrated to validate understanding. The program began accepting referrals in January 2011. The electronic health record was modified to include documentation of time in and out of Kangaroo care and with whom the infant was in Kangaroo care. infant placement. Implementation. MSN. the Birthing Center began training the nurses on Kangaroo care and implementation soon followed. Pediatric. such as 911 calls. this program will improve infant. IBCLC. The specific activities are adapted to the anticipated discharge needs of the infant. In the fall of 2009. At Home with Your Baby Deborah Raines. PhD. the evaluation of parents and staff has been overwhelmingly positive and the funding has been extended for a second year. and anesthesia providers were educated about Kangaroo care and the Birthing S53 . prepared childbirth classes. Lakewood Hospital. midwifery. RNC. and overall family well being. and hospital readmission. Lakewood. Patient education included handouts on Kangaroo care for distribution during prenatal appointments. Data are being collected on the specific outcomes of parent confidence and competence as caregivers as well as on unscheduled use of health care resources on infants. Registered nurses will be held accountable for daily teaching and documentation.1111/j. Parents would hold infants every day.2012. Parental Accountability: Parents will be actively involved in teaching and take responsibility for learning. The use of Kangaroo care is truly a nursing intervention.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. and family. breastfeeding. parents being unprepared to take their infants home. along with the American Academy of Pediatrics’ guidelines for discharge planning. AK Melissa Heath. NNP-BC. especially in conjunction with breastfeeding.x Rebecca Heimann. RN.01360. Outcomes. bonding. MSN. The current practice in the Providence Alaska Medical Center Maternity Center is to perform sponge bathing under a radiant warmer on newborns within 2 hours of birth in the absence of birth stress JOGNN. lactation consultants report a decrease in the incidence of delayed latch and breastfeeding problems. RN. Long-term infants get a journal with weekly pictures. Providence Alaska Medical Center. Discharge map created: Outline discharge teaching with daily accountability for updates. AK http://jognn. As barriers were identified.awhonn. and a discussion of unit expectations. S1-S118. Our parent surveys improved from the 30th percentile for discharge planning to the 99th percentile. Implications for Nursing Practice Kangaroo care assists the infant with transition and facilitates initial breastfeeding. mother. Parents should be actively involved and accountable for knowledge acquisition. Our evaluations have been overwhelmingly positive. Discharge mapping is an excellent tool to ensure that parents have covered all discharge information. a literature review. Discharge Planning in the Neonatal Intensive Care Unit Purpose for the Program o improve parents’ ability to care for their infants at discharge. This nursing intervention quickly became a model of care for the Birthing Center. Anchorage. and Evaluation The clinical manager recruited two staff nurses. Between 90% and 98% of appropriate infants are placed in Kangaroo care. Nurses’ Commitment to Best Practice Infant Care and Family Bonding Founded on Evidence-Based Research: A Journey of Infant Bathing Purpose for the Program he Professional Practice Committee hypothesized that we could improve postpartum wellborn baby care by switching from sponge bathing to immersion bathing. and teaching. Issues with discharge planning. Implementation. A research review revealed evidence supporting the theory that immersion T S54 bathing improved temperature stability. FL Keywords neonatal intensive care unit (NICU) Newborn Care Poster Presentation Implications for Nursing Practice Discharge planning should begin on admission. Videos will be added to our television system for parental viewing. It is not only a teaching process but should involve the parents in every aspect of their infants’ care. Anchorage. The percentage of appropriate infants in Kangaroo care following birth is reviewed monthly. Parents get a picture on admission. The more involved the family is. the more prepared they are to care for their infant at home. T Proposed Change To implement the following improvements in the neonatal intensive care unit (NICU): r r r r Cultural: More parental involvement. and it is utilized throughout the hospital stay and families are encouraged to continue Kangaroo care at home. Parents state that they feel at home within the NICU and are prepared to care for their infants. holding. Memorial Hospital Miramar. including rooming in. Loughren. Kathy J. and the associated risks were reviewed.1552-6909. Providence Alaska Medical Center. The classes were mandatory for NICU nurses and included the following: an emotional approach. and parental education. Families have reported increased satisfaction with their birthing experiences. We offer all parents rooming in. Miramar. We must change our culture of isolation to one of inclusion. Anecdotally. Infants also are placed in Kangaroo care shortly after a cesarean birth while the mother remains in the operating room. 41. 2012. nursing leadership worked on the issues to minimize interruptions of Kangaroo care. it is beneficial to the infant. DOI: 10. Nurses must be held accountable for discharge teaching on a daily basis.org . Teaching: A parent admission and discharge tool was created. r Infants at risk of transmission of hepatitis B and human immunodeficiency virus from maternal sources will be bathed within 2 hours of birth.3% for July 2011 and Sharp Mary Birch Hospital for Women & Newborns reported a 0% no-show JOGNN 2012. the Professional Practice Council is developing a training video. Purpose for the Program LCCE. The outpatient program is open to the community at-large allowing for quicker access to a follow-up hearing screening. BS. Proposed Change To increase the number of patients receiving outpatient hearing rescreenings. San Diego. Also. temperature regulation. Supplement 1 rate (the overall program no show rate is currently being calculated by the Regional Hearing Coordinating Center). and signs and symptoms of infant distress. respiratory distress. we have seen 382 outpatients with a steady increase each fiscal year. R. improved breastfeeding. the family is received and escorted to the outpatient clinic by a hearing screening technician. S55 .5◦ F for 2 to 4 hours. and increase revenue. Compared to our region. Hands-on training of nurses and techs will be conducted to assure comfort and competency in practice. 41. Nurses also reported that breastfeeding and skin-to-skin bonding time often was interrupted to complete baths in the allotted 2-hour recovery time. These tools will be presented to the staff at regularly scheduled staff meetings. CA T Keywords outpatient community hospital growth Newborn Care Poster Presentation all infants to have a hearing screening prior to discharge. and Sharp Mary Birch Hospital for Women & Newborns now receives revenues from the insurance companies and the state for MediCal and/or uninsured patients. and guarantee an appointment well within the state recommended 4-week timeframe. Proceedings of the 2012 AWHONN Convention Keywords bathing education thermoregulation infant stability newborn care Newborn Care Poster Presentation or trauma. increased infant relaxation. decrease the time between the initial hearing screening and the follow-up hearing screening. ensure a reminder call is made. exhaustion.7◦ F to 99. Tub bathing appears to be more effective than sponge bathing at maintaining body temperature and preventing temperature loss. Implementation. Stable temperature defined as 97. Since the outpatient program began in October 2008. Implications for Nursing Practice Increased parental involvement in newborn care results in greater uninterrupted bonding time. The outpatient revenues previously went to other hospitals within the community. The goals for this project are consistent immersion bathing per guidelines. New parents are relieved to come back to the hospital where they gave birth versus going to a different clinic and navigating a new health system. Outpatient Newborn Hearing Screening Program Nicole Giangregorio. The region reported a no-show rate of 12. Outcomes. and hypoglycemia. and increased revenue. and Heath. as well as improved neonatal outcomes from decreased cold stress and calmer stabilization. increased patient satisfaction. Currently. M. which incorporated these key principles: r r r Delay infant baths 2 to 4 hours to establish thermoregulation and decrease negative side effects of hypothermia. Vol. Outcomes. Each outpatient appointment receives a reminder phone call 48 hours prior to their appointment. and Evaluation The Professional Practice Council presented their research and findings to the Nursery Committee and received permission to proceed with a practice change. CLE. Proposed Change The Professional Practice Committee proposed a policy and procedural change to immersion bathing founded on evidence-based research. extended skin-to-skin contact in the postpartum period. On the day of their appointment. increased parental involvement and education covering proper positioning. Sharp Mary Birch he Newborn Hearing Screening Program is a Hospital for Women & California state mandated program requiring Newborns.I N N O VAT I V E P R O G R A M S Heimann. As a result. and environmental or social distractions during the immediate postpartum period. studies showed there is no difference in umbilical cord infection and healing rates and infants appeared more relaxed and less agitated during tub baths. Implementation. Implications for Nursing Practice It is important for families to have their outpatient follow-up appointments within the same health system for convenience. our outpatient no-show rate is considerably lower. policy. complete all necessary paperwork. and Evaluation The outpatient program allows our hospital to schedule the follow-up appointment for all wellbabies prior to discharge. our patients are more satisfied. including increased oxygen consumption. Parental involvement is minimal because of decreased mobility from anesthesia. and care competency. Sharp Mary Birch Hospital for Women & Newborns additionally offers an outpatient hearing program for our well-baby population leading to increased patient satisfaction and delayed appointment times. EdD. such as drug and diet interaction with milk. CCE. Bayne. RNC-OB. Christiana Care Health System. hospitals offer the full support necessary to meet enduring. RN. DE Keywords comprehensive breastfeeding program Christiana Care Health System (CCHS) Newborn Care 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. and nearly 75% do not provide maternal support after discharge. Mothers may initiate a call at any time during their breastfeeding experience when they encounter questions or concerns. breastfeeding hotline that is staffed by lactation consultants.S. and provide anticipatory postdischarge guidance so that a successful support program would be in place to meet the aforementioned goals.2012. Our facility maintains a free. 41. IBCLC.1% breastfeed at 1 year. Christiana Care Health System. Results of both projects clearly indicated the need to initiate breastfeeding education activities during prenatal classes. DOI: 10. Ten themes emerged and specific. maintain momentum during the inpatient phase. 2012. This program promotes the development of knowledgeable mothers and health care providers. Recent Centers for Disease Control and Prevention data suggest less than 4% of U.awhonn. Findings were then compared to the nurses’ perceived breastfeeding barriers by care area. Lydia Henry. RN.025 mothers who breastfed and called during 2009 were examined.x http://jognn. which determined the nature of maternal concerns. The Surgeon General’s Call to Action to Support Breastfeeding underscores this critical need. As part of this program. and Evaluation Christiana Care Health System has built an enduring lactation program available across the continuum of perinatal care aimed to meet these action calls.org . particularly concerning milk supply. 60. NNP-BC. Lynn E. Information and available resources that are appropriately timed and offered when the mother is ready to learn improve the chances that the mother will be able to process and retain the shared information.1111/j. Outpatient clinicians can offer anticipatory guidance based on consistent patterns of data across the postpartum period. S1-S118. logs document telephone conversations. as defined in a separate performance improvement project. Inpatient nurses should address predictable areas of concern with new mothers. Support is offered to mothers and other perinatal clinicians by experienced lactation consultants to overcome breastfeeding obstacles. noting low priorities for breastfeeding. and use of nonevidence-based practices as barriers to enduring breastfeeding. DE Elizabeth Chance. To ensure that S56 mothers are being offered relevant information. Outcomes. committed breastfeeding. PhD.1552-6909. MSN. JOGNN. hospitals fall short in breastfeeding rates and duration. predictable breastfeeding topics developed at key points during the first year of life. and weaning among other issues. Christiana Care Health System. stooling patterns. Newark.6% breastfeed at 6 months. DE Data from 1. and 34. D Proposed Change To create a comprehensive breastfeeding program to meet the challenges stated above Implementation. logs were subjected to qualitative analysis. Newark.01360. and pumping. baby behaviors.9% of mothers initiate breastfeeding. This challenges an institutional ability to meet the Healthy People 2020 goals to have 81.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. Newark. 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