Pediatric Nurse Practitioner NYP/Columbia University Yonkers, New York, United States
Abstract:
Introduction: As surgical outcomes continue to improve for infants with complex congenital heart disease (CHD), the need to support long term neurodevelopmental (ND) outcomes has become apparent. Infants with CHD are at increased risk for ND deficits, and behavioral and mental health problems compared to their well peers. Many of these risk factors are non-modifiable related to disease processes or to the nature of prolonged inpatient status. The burden falls upon clinicians to examine unit practices and the environment to discover opportunities to augment the previous as much as possible to facilitate the most favorable environment for infant development. At Columbia University Medical Center, a 17-bed infant cardiac unit serves infants under 12-months with CHD in perioperative phases. A previous unit-based QI project assessed bedside nurse comfort level with mobilizing infants with invasive devices as well as barriers to achieving these ends. During 2020 and 2021, nurses were in-serviced on standardized line securement and holding algorithms. Weekly interdisciplinary developmental care rounds were incorporated during this time. The researchers then evaluated comfort level and perceived cultural change after education intervention.
Methods: After assessing unit culture and barriers to holding, a holding algorithm was added during a second PDSA cycle. A 6-question survey was developed to query nurses about comfort level and perceived cultural changes with regards to mobilizing infants with invasive devices. Responses were given in the affirmative or negative (Strongly agree, agree, disagree, strongly disagree). Educational intervention components: (1) algorithm for determining safe transfer out of bed, (2) demonstration and teach back, (3) training of unit champions. Survey responses served as the outcome variables in the analysis.
Results: Of the 67 nurses in the infant cardiac unit, six were excluded due to leave of absence. Nurses hired within 12mo were asked to fill out the comfort-level questions (Q1-3). There were 51 respondents (84% response rate, N=61) to the survey. 86% reported comfort mobilizing infants with arterial lines and umbilical lines, 71% reported comfort mobilizing infants with chest tubes. 82% agree or strongly agree culture has changed with mobilization with umbilical lines, 80% with arterial lines, 70% with chest tubes.
Conclusion: When pre-intervention surveys were conducted in August 2020, nurses noted comfort, safety and support as barriers to mobilizing patients in the infant cardiac unit. Two years later, nurses are reporting a perceived culture shift with regards to umbilical and arterial lines following standardization of line securement and initiation of holding algorithm. In the next PDSA, we need to evaluate chest tube management, comfort level, and culture. Strong commitment from leadership, staff education, family support, value of parents as the primary caregivers is needed, and policies to increase consistency of practice. Future directions: parent surveys assessing understanding of PT/OT/SLP role, experience with colostrum care, family advisory council partnership. Expand outpatient to include broader CHD population.
