Pediatric Resident NewYork-Presbyterian Morgan Stanley Children's Hospital New York, New York, United States
Background: Skin-to-skin care (SSC) in the NICU provides many benefits to premature infants, from the immediate effects of improving physiologic stability and sleep patterns to the long-term association with improved scores on developmental assessments in toddlerhood and more efficient brain networks in adolescence. It additionally strengthens the infant-parent dyad by supporting milk production and protecting against postpartum depression. Despite this, SSC has not been universally adopted by NICUs across the world. Common barriers include inadequate space and equipment, low comfort with SSC, and lack of guidelines for how to safely perform SSC. Objective: To increase the rate of SSC during day of life 0 to 3 for infants born between 24 weeks and 34 weeks from 33% to 85% by April 2023. Design/Methods: This QI study was performed in a Level IV 58-bed NICU, including infants born from 24 to 34 weeks, excluding patients with hemodynamic instability, chest tube in place, neural tube or abdominal wall defects, high frequency ventilation, or a critical airway. SSC was documented by bedside nurses in the electronic health record. Stakeholders in implementing these practices include physicians, advanced practice providers, nursing staff and leadership, physical and occupational therapists, lactation specialists, and respiratory therapists. Key drivers identified include low level of staff knowledge and understanding of safe SSC practice and lack of parental knowledge about the possibility for SSC. In September - October 2023, we implemented an educational bundle focused on disseminating written SSC eligibility guidelines, providing nurse education, and presenting on safe infant transfer at skills days. Future initiatives to be implemented from November 2023 - March 2024 include bedside posters for parents to learn about the benefits and process of SSC, including discussion of SSC readiness on daily rounds, and early introduction of SSC to parents during prenatal consults. The rate of SSC will be measured weekly though these PDSA cycles, and the data will be presented in a run chart.
