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nurseweek.com Related SiteCalifornia Hospital Medical Center | | Physiologically unprepared for life outside the womb, preterm infants have traditionally undergone intense, intrusive, and medically focused care. But what happens when preemies get care that focuses on developmental support? The NICU at California Hospital Medical Center has provided an answer: dramatically improved outcomes.How it startedThe goal of CHMC’s developmental care program is simple: Support the infants’ abilities while minimizing stress. “Developmental care focuses on what infants can do at that state in their development; uses therapeutic interventions only to the point that they are beneficial; provides for the development of the newborn-family unit; and adheres to the principle that, above all else, caregivers should do no harm,” explained Linda Wynsma, MSN, RN, the neonatal clinical nurse specialist at CHMC’s NICU who championed the project and spearheaded its implementation.The developmental care program started as a grassroots program by the nurses, Wynsma said. In 1994 a group of NICU nurses attended a conference on developmental care and began implementing techniques individually. In 1996, the hospital administration accepted a multidisciplinary task force proposal and budgeted $65,000 for the developmental care program.“Once the administration picked it up, they supported it wholeheartedly,” Wynsma said.CHMC serves the economically disadvantaged population surrounding downtown Los Angeles and cares for a large number of high-risk, very low birth-weight infants. The hospital does about 400 deliveries a month, and each month 50 to 55 infants are admitted to the NICU. The challenges facing these infants and their families once they leave the hospital strongly influenced the developmental care program. “We felt it was critical to give these babies the best start possible,” Wynsma said.What’s involvedTo provide the ideal environment for infant development, CHMC’s NICU underwent a sensory transformation. Lights are dim and regionalized, and individual cribs are covered with quilts. Noise has been greatly reduced by installing a visual alarm system, limiting overhead pages, and monitoring continuous and peak noise levels.The program supports early extubation from mechanical ventilation, early and consistent feedings (preferably with breast milk, which increases motility), judicious use of antibiotics, and coordinating therapeutic and diagnostic interventions to reduce infant disturbance. Nurses are required to use new practices that keep infants positioned as if in utero. The program also encourages “kangaroo care,” where parents hold the infants against their chests for extended periods of time each day.Does it work?The program has been in place since 1997. In that time, they’ve tracked the progress of infants weighing less than 1 kilogram (approximately 2.2 pounds) at birth and compared this data to that of previous years. Wynsma was responsible for tracking and monitoring the physical progress of the infants, and the hospital’s MIS department provided information about hospital charges. The results are impressive: length of stay decreased by 17 percent (17 days), ventilator days decreased by 43 percent (16 days), days of supplemental oxygen decreased by 17 percent (13 days), and per patient charges decreased by 19 percent (or $53,000 per baby).Making it happenEqually time consuming, and perhaps even more challenging than data collection, was the task of educating the staff and implementing the principles of developmental care.“It was very hard, and not everybody cooperated,” recalls Celia Huber, RN, a 10-year staff veteran of the NICU. “We did a lot of talking, teaching, and encouraging others to cooperate with us. Now everyone—from respiratory, to social workers, to OT—is collaborating and gets the message that this is really good for the babies.”Initial implementation required a lot of retraining, monitoring, feedback, and education, Wynsma said. And the education process continues with conferences, inservice, and developmental updates at every staff meeting.Despite the challenges of the developmental care program, nurses who staff the NICU enjoy working in the new environment.“You walk into the unit and the atmosphere is very calm,” said Imelda Dyan, RN, who’s been in the NICU since 1989. “It’s relaxing to the babies, relaxing to the staff. People have gotten used to the peaceful feeling in this environment.”Looking aheadThe NICU developmental care program at CHMC was recognized by the Healthcare Association of Southern California as one of its three “Best Practices” (it was also the only project that involved nursing), but CHMC doesn’t plan to rest on its laurels. In addition to continued education and training, the hospital plans to provide a few of its NICU nurses with Newborn Individualized Developmental Care and Assessment Program (NIDCAP) certification, which requires comprehensive training in developmental care practices. These nurses will become unit experts, constantly enforcing developmental concepts and enhancing infant care. |
