Ensuring Quality in the NICU: Translating Research Into Appropriate Clinical Care

Neonatal Twin Cobedding: A Mixed Method Study of Policy, Practice and Staff Perceptions in Australia

AIM

To explore neonatal unit policy and practice, and neonatal healthcare workers' experiences, beliefs and perceptions of twin cobedding in Australia.

DESIGN AND METHODS

A two-part convergent mixed methods design was used. Part 1 data were collected via an online survey of neonatal units. Part 2 data were collected by focus groups and interviews with healthcare workers. Findings were integrated to create final results.

RESULTS

21 neonatal units, and 17 healthcare workers participated in this study. Significant variations in twin cobedding practices were reported within and across neonatal units. Practice variation was influenced by several interlinked factors, captured in four themes: (1) Policy-Driven Practitioners in a Policy Vacuum; (2) Evidence, Knowledge and Education; (3) Personal Beliefs and Practice Observations; and (4) "The Parent Owns that Baby"-Being Family-Centred.

CONCLUSIONS

Due to widespread practice and policy variations, and a lack of evidence-based education for staff, healthcare workers appear to be making individual decisions regarding cobedding practice, potentially creating confusion for twin families navigating care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Improvements to twin cobedding practice education are needed to enable clinicians to support twin families in their care. Separation of twins in neonatal units needs to be addressed, regardless of twin cobedding practice. Research identifying benefits and any potential risks of twin cobedding practice is required.

IMPACT

Neonatal healthcare workers are policy-driven practitioners who value clear evidence and education to confidently support the families in their care. It is important that evidence-based guidelines for twin cobedding are developed to support them in family-centred clinical practice.

REPORTING METHOD

MMAT guidelines were used to prepare this manuscript.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Virtual Visitation in a Neonatal Intensive Care Unit: Insights From 5 Years Using a PDSA Model to Improve Family-Centered Care

This 5-year study evaluated a virtual visitation implementation initiative in a neonatal intensive care unit. Our objectives were to (1) use the Plan-Do-Study-Act methodological framework to implement a virtual visitation program, (2) investigate whether implementation of virtual visitation could be done with no patient harm and minimal workflow disruption, (3) foster a top-down participatory structure for decision making, and (4) evaluate parent use and satisfaction. The study involved a qualitative and quantitative description of cycles and results. Routine collection of outcome data allowed problems that arose as a result of changing practices to be quickly and efficiently addressed. The study results suggested that the virtual visitation implementation initiative in a neonatal intensive care unit using Plan-Do-Study-Act cycles helped create an environment of trust and provided benefits. A steady increase in the use of virtual visitation by parents and their extended families indicated utilization. During the COVID-19 pandemic, virtual visitation helped families feel connected with each other and their neonate, despite being in separate locations.

Survey of Neonatal Intensive Care Unit Nurses' Use of a Motion/Sound Infant Seat

BACKGROUND

Perinatal substance exposure is an increasing concern in infants being cared for in neonatal intensive care units. Current recommendations support nonpharmacologic treatments for this population of infants. Multimodal (motion, sound) seats are often employed to soothe infants.

PURPOSE

The purpose of this study was to survey neonatal intensive care unit nurses on their practices regarding the use of a motion/sound infant seat.

METHODS

Sixty-six nurses (52% of 126 total nurses) completed the survey about their self-disclosed practices that included (1) reasons for use; (2) rationale for choice of settings of motion and sound; (3) duration of time infants spent in seat in one session; (4) perception of positive infant response; (5) who places infants in the seat; and (6) nursing instructions dispensed prior to use.

RESULTS

Chief reasons for use were infant state, lack of persons to hold infants, and a diagnosis of neonatal abstinence syndrome. Rationale for choice of motion and sound settings included trial and error, prior settings, personal preferences/patterns, assumptions, and random selection. Nurse responses regarding the amount of time the infant was placed in the seat in a single session ranged from 10 to 360 minutes, with determining factors of infant cues, sleeping, feeding, and someone else to hold the infant.

IMPLICATIONS FOR PRACTICE

As nonpharmacologic treatments evolve, nurses need guidelines for safe, effective interventions to care for infants.

IMPLICATIONS FOR RESEARCH

Further research is necessary to ascertain the responses of withdrawing infants and to establish guidelines and education for use of the motion/sound infant seat.

[Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants]

BACKGROUND

Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs.

METHODS

We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process.

RESULTS

Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days.

CONCLUSIONS

The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs.

Partnering With a Medical Malpractice Insurer to Improve Patient Safety and Decrease Risk

Implementing evolving science into clinical practice remains challenging. Assimilating new scientific evidence into clinical protocols and best practice recommendations, in a timely manner, can be difficult. In this article, we examine the value of partnering with a captive medical malpractice insurance company and its Patient Safety Organization to use data and convening opportunities to build upon the principles of implementation science and foster efficient and widespread adoption of the most current evidence-based interventions. Analyses of medical malpractice and root-cause analysis data set the context for this partnership and acted as a catalyst for creating best practice guidelines for adopting therapeutic hypothermia in the treatment of neonatal encephalopathy. What follows is a powerful example of successfully leveraging the collective wisdom of healthcare providers across specialties and institutional lines to move patient safety forward while managing risk.