Teams are hard at work implementing change and piloting creative approaches. A particular area of emphasis has been on skin-to-skin care. According to some NICU parents, the first time they considered themselves real parents was the first time a nurse encouraged them to hold their baby skin-to-skin. Kangaroo care enables moms to regain the temporarily lost relationship with their child, and enables fathers to experience the beginning of a new relationship. Most importantly for our initiative, studies have found that mothers increased their milk volume, doubled rates of successful breastfeeding and increased duration of breastfeeding with skin-to-skin holding. To help increase kangaroo care frequency PQCNC is exploring partnering with the March of Dimes to make "Close to Me" - a comprehensive set of awareness and educational activities, tools and products designed to increase the onset and frequency of Kangaroo Care.
Updates
12 Newborn Critical Care Centers (NCCC) who have been working together to increase by 50% the number of babies receiving mom’s milk at 28 days of life met to share successes and challenges, hear from parent’s whose infants were VLBW and had mother’s milk, and, support each team to continue to work on this important aim. During the course of the day there were presentations and 'town hall' style meetings on
- building teams and driving improvement
- optimizing the growth of the VLBW infant
- transitioning from gavage to oral feedings
as well as two well-received parent panels that discussed
- kangaroo care and strategies for successful implementation
- from pumping to nursing: first approach, first month and transitioning to breast feeding
and, of course, ample time for teams to share tools and techniques.
Teams are hard at work implementing change and piloting creative approaches. To highlight one activity among many this month: those teams currently using feeding protocols have shared them with the other teams in this initiative.
Feeding guidelines provide a standardized approach to enteral nutrition for the Very Low Birth Weight Infant (VLBW) and minimize periods where feedings are held. Providing early small volume feeds using mom’s colostrum every chance you get as soon as you get it is an important aspect of most feeding guidelines and sends a powerful message to mother’s emphasizing the importance of fresh human milk.
Comprehensive feeding guidelines address initiation and advances in volume, fortification, the need for additional protein and how to manage residuals. Several studies inform advancement of feeds, fortification and additional protein; however more studies are needed to guide practice of when to start feedings and the use of donor milk. Despite the need for more research and the variations between units on the components of a feeding guideline, a systematic review of standardized feeding protocols in 6 units showed reduction of NEC from 4.6% to 2.2%.
Teams have continued to work on Kangaroo Care (KC) and many have shown an increase in opportunities for KC on more shifts. Visual cues to are credited with part of the increase including posters for families and staff, stickers on charts or beds and new written material promoting the practice. A “ challenge contest” between day shift and night shift @ one hospital increased KC overall from 40% to 63% of the time for eligible babies. Focusing on KC brings new questions to light for instance, must KC be halted for the entire time when babies require phototherapy? Might the practice continue with a phototherapy blanket or might phototherapy be interrupted for this important practice once a shift after bilirubin peaks? These and other questions only surface when examining our habits and policies. Newly introduced this month is the role of feeding guidelines for the VLBW baby and several teams have forwarded their guidelines to be placed on the extranet.
Where: McKimmon Center, 1101 Gorman St, Raleigh, NC 27606
When: Thursday, May 19, 2011 9:00 - 3:30
What: All three primary team members (physician champion, nurse champion, senior hospital adminsitrator) are encouraged to attend. CME Category I credit, lunch and materials will be provided at no cost.
The first webinar was held during the second week of February and 10 of the 13 teams were able to sign on to a virtual classroom website. Centers are testing a variety of small changes including the use of pumping logs, best way to ascertain mom’s intention to provide milk for her baby, and providing colostrum early and often. Additionally, several centers have instituted new classes for staff, opportunities for staff to shadow lactation consultants, created posters and surveyed staff regarding knowledge and attitudes. The second webinar is scheduled in March.
The first learning session was held during an icy week in the middle of January and 11 of the 13 teams committed to increasing the number of mother’s who provide milk for their premature babies were able to attend, though many teams were smaller than planned. Teams worked to create plans to test activities believed to be “potentially better practices” when they returned home. Didactic sessions were led by Laurie Dunn, MD and Polly Sisk, PhD, who are leading the initiative with Linda Smith, RN, MSN. Family faculty planning to speak with the teams about the experience of care were unable to attend because of the weather. While testing new ways of delivering care, nurses are continuing to collect information about care practices and processes during the first 28 days a baby is in a Newborn Critical Care Center. These teams are meeting monthly during the active phase of the initiative and sharing what’s working as well as what’s not working, offering each other support and reflection on activities and data collection.
More information including webcasts, fact sheets, and other resources available here.
13 Hospital Teams in Newborn Critical Care Centers across North Carolina have gathered baseline information and are entering the data into a secure web based data center. Each unit will send 3-6 participants to the first learning session the second week of January. During the workshop, teams will plan the activities expected to increase the numbers of mothers successfully pumping enough milk for their premature babies. According to Dr. Polly Sisk “Most health care providers have no difficulty talking with mothers about providing breast milk for their VLBW infants if they have already made the decision to breastfeed. However, many of us are uncomfortable talking with mothers who plan to formula feed about providing mothers’ milk even though we have ample evidence of ifs benefits for VLBW infants. Our hesitation stems from concern that this type of discussion may be perceived as coercive and a source of increased anxiety for mothers. Despite these common assumptions several studies (Jaeger 1997, Miracle 2004, and Sisk 2006) indicate that mothers want evidence-based information about their feeding choices, these discussions do not increase anxiety (Sisk 2006), and these discussions are associated with high rates of pumping initiation and mother’s milk feeding in VLBW infants. “