Nurse Practice Specialist Boston Children's Hospital Boston, Massachusetts, United States
Abstract:
Background: Infants born with Congenital Heart Disease (CHD) are at higher risk of immature brain development, cardiopulmonary bypass-related brain injury, neurodevelopmental delays and have greater potential for long-term disability. Individualized Family Centered Developmental Care (DC) is a standardized approach utilized in Newborn Intensive Care Units (ICUs) to support the neurodevelopment of high-risk premature infants. Newborn Individualized Developmental Care and Assessment Program (NIDCAP), is the only evidence-based, comprehensive, internationally recognized DC program citing improved outcomes for premature infants and positive behavioral outcomes through school age. NIDCAP principles include infant support, environmental awareness, and parental integration in care. The purpose of this project is to illustrate the feasibility and sustainability of integrating a specialized DC program into the Cardiovascular ICU at a quaternary care teaching hospital using an interprofessional approach.
Description of Project: As part of a Qualitative Improvement (QI) study, an interprofessional, Developmental Care Committee (DCC) recruited and trained developmental care champions from various specialties (Nursing, Psychology, Cardiology, Surgery, Respiratory Therapy, Child Life, Physical Therapy, Occupational Therapy, and other clinical providers; n=42 members) on NIDCAP principles). The DCC meets monthly to determine NIDCAP initiatives then disseminates best practice education via group huddles and individualized train-the-trainer methods. NIDCAP principles were modulated as follows: light and sound, reading cues, therapeutic positioning, and documentation. Additionally, sub-committees addressed specialized aspects of NIDCAP including: guideline development, infant holding, QI auditing and prone positioning.
Project Highlights: Between 2017 and 2022, interventions (including both bedside and formalized interdisciplinary rounding, NIDCAP module education, mandatory yearly trainings, poster education, quarterly newsletter publication and multidisciplinary staff meetings with medical and nursing leadership) were performed (see Figure1). Several larger initiatives (Infant holding in the CICU) required higher fidelity training and collaboration with the hospital-based simulation program. Guidelines were created for developmental care, holding of high-risk cardiac infants, delirium, and sternal precautions. QI efforts included bedside auditing of basic developmental care practice, holding, and documentation of developmental care in the medical record, demonstrating increases of these practices following intervention.
Next Steps: Cardiovascular ICU DC was established with QI efforts and systematic education and training methods. Our next steps include completing NIDCAP provider certification and NIDCAP unit-wide certification.
