PC1137: Reducing Barriers to Skin to Skin in the Neonatal Intensive Care Unit, a Trauma Informed Care Quality Improvement Initiative

Purpose/Objectives: Infants experience unintended trauma as a part of admission to the neonatal intensive care unit (NICU), including separation from their parents. Skin to skin holding is a technique that has been shown to have many benefits for both infants and their parents including improved cardiorespiratory stability, glucose stability, temperature stability, and greater success in breastfeeding. Premature infants are often not held skin to skin with their parents for an extended period of time after birth due to perceived instability or concern for vulnerability of the infant. Trauma informed care is an approach to care with strategies to create a buffer for stress and improve outcomes for infants and their families.
Decrease the median time to first hold for infants born < 30 weeks gestation in the Doernbecher NICU from 5.7 days after birth or end of the neuroprotective 72-hour protocol by 50% to 2.8 days by July 2021.

Design/Methods: A retrospective chart review of all infants born < 30 weeks gestation at Oregon Health and Science University (OHSU), or transferred in prior to 72 hours of life was conducted from January 2020 through March 2021 documenting demographics such as gestational age, birth weight, date and time of birth, respiratory support history, line history, phototherapy history and peak bilirubin level. Date and time of first hold was utilized to determine time to first hold (in days), as the outcome measure. Adverse events related to holding were documented as a balancing measure. We utilized the Institute for Healthcare Improvement Model for Improvement with Plan-Do-Study-Act (PDSA) cycles to prospectively track from March 2021 onward the same demographic, outcome, and balancing measures. Interventions focused on education surrounding benefits for all key stakeholders, awareness of policies, standardization of processes, and visual reminders at bedside. Data were plotted on a run chart.

Results: A total of 89 infants born at 23.0 – 29.6 weeks gestation met criteria for inclusion from January 2020 through April 2022. At baseline, median time to first hold from birth or end of the neuroprotective 72 hour protocol was 5.7 days. After interventions, median time was 1.87 days in April 2022, without an increase in adverse events related to holding.

Conclusion/Discussion: Multidisciplinary quality improvement methodology, coupled with an approach to trauma informed care, was utilized to improve median time to first hold for infants born < 30 weeks gestation to 1.87 days.