O1039: Kangaroo Care as a Cultural Norm in Neonatal Intensive Care Unit: A 7-year Regional Quality Improvement Project

Purpose/Objectives: 1) To evaluate the outcome of the implementation of Kangaroo Care (KC) improvement bundle at Kaiser Foundation Hospitals - Southern California (KFH-SCAL) NICUs.
2) To increase the rate of KC among NICU patients during parental presence.

Design/Methods: This was a quality improvement (QI) initiative at KFH-SCAL involving its 13 NICUs (5 surgical and 4 non-surgical level III and 4 level II) focusing on implementation of improvement bundle intended to safely increase rate of KC.
All infants admitted to NICU during these 2 time periods were included: Pre-intervention period (Jan 2015-June 2018) and Post-intervention period (July 2018-December 2021).
A comprehensive KC improvement bundle was implemented that consisted of several elements: multidisciplinary team-based approach and collaboration; fostering engagement, communication, and accurate documentation; education and sensitization of health care providers and family members; and lastly simultaneous reinforcement of ongoing practice. These changes were implemented and evaluated as part of Plan-Do-Study-Act (PDSA) cycle.
Primary outcome measure was an increase in KC in all participating NICUs. Data were collected monthly from a structured data element in the electronic medical record used by nursing staff for charting of KC.

Results: Implementation of improvement bundle resulted in a sustained increase in overall rate of KC in KFH-SCAL NICUs from a baseline of 40% in 2015 to 67% in 2021. An increase in rate of KC was also demonstrated across all levels of NICU care with an increase of 67% (37% in 2015 to 62% in 2021) in surgical NICUs, 62% (45% in 2015 to 73% in 2021) in non-surgical Level III NICUs, and 58% (48% in 2015 to 76% in 2021) in Level II NICUs.

Conclusion/Discussion: Implementation of KC improvement bundle significantly increased KC in infants admitted to KFH-SCAL NICUs. Its feasibility and sustainability were possible through a QI approach.