200 - Increasing Kangaroo Care in a Level IV Neonatal Intensive Care Unit: A Quality Improvement Initiative
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 200 Publication Number: 200.439
Giselle Gozum, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Emily Ahn, New York-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Rebecca Miller, NewYork-Presbyterian Komansky Children’s Hospital, Manhattan, NY, United States; Charlene Thomas, Weill Cornell Medicine, New York, NY, United States; Kristen Fuccillo, NewYork-Presbyterian Hospital, New York, NY, United States; Tricia Budway, NewYork-Presbyterian Komansky Children’s Hospital, Ramsey, NJ, United States; Snezana Nena Osorio, Weill Cornell Medical College, New York, NY, United States; Emily Echevarria, Weill Cornell Medicine, New York, NY, United States
Clinical Fellow NewYork-Presbyterian Komansky Children’s Hospital New York, New York, United States
Background: Kangaroo care (KC), which is the practice of skin-to-skin holding between a caregiver and an infant, has many benefits for both infants and caregivers and is safe for critically ill infants in the neonatal intensive care unit (NICU). Although the American Academy of Pediatrics endorses the practice of KC in NICUs, there are no established standards for its provision and many barriers to practice. Due to these, KC rates in our NICU have remained low. Objective: To increase the frequency of KC during the first week of life by 50% and to decrease the age at first KC session by 50% by June 2023. Design/Methods: This ongoing quality improvement (QI) study utilized the Model for Improvement. A key driver diagram was developed and interventions were derived from secondary drivers. Measures included mean number of days that infants received any KC in the first week of life (process), mean age at first KC session for infants with KC data available (process), rates of breast milk feeds at discharge (outcome), and unplanned extubation and line dislodgement rates (balance). Statistical process control charts were used to analyze data and Associates in Process Improvement rules for special cause variation were applied. Results: There was an increase in the mean number of days that infants received any KC in the first week of life from 1 to 1.2 days in all infants. In preterm infants, there was an increase from 0.9 to 1.5 mean days (Figure 1). This centerline shift was correlated with data distribution to staff and protocol review. There was a 47% decrease in the age at first KC session for all infants from 8.6 to 4.6 days of life (DOL) and a 46% decrease in preterm infants from 12.3 to 6.6 DOL (Figures 2 and 3). This centerline shift was correlated with KC protocol development, faculty and staff KC presentations, and parent kangaroo-a-thon events. There was no change in rates breast milk feeds at discharge. There was no increase in rates of unplanned extubation or line dislodgement.
Conclusion(s): This ongoing QI initiative successfully improved the frequency of KC and decreased the age at first KC session, without increasing adverse events. Protocol development, data distribution to faculty and staff, and reinforcement of KC principles were key contributors that led to a culture shift, which improved KC timeliness and frequency. Next steps include evaluating the relationship between KC provision and breast milk feeding during the first month of life. QI methodology is an effective tool for improving rates of KC, a beneficial and safe intervention for caregivers and their hospitalized infants in the NICU.
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