August 13, 2019
Yolanda Douglas’ son, Cayden, was born premature, requiring specialized care at Women & Babies Hospital’s NICU. The Douglas family participated in rounds with the NICU staff.
Nearly one in 10 infants in Lancaster County are born prematurely, according to the Pennsylvania Department of Health. Many of these babies require care in a Neonatal Intensive Care Unit (NICU) to ensure specialized care and treatment.
The 29-bed NICU at Women & Babies Hospital provides advanced care for premature infants born as early as 23-weeks gestation and infants that are born full term, but require specialized medical care. Family-centered care is woven throughout the continuum of care, which includes caring for not only the infants, but also their parents and family members.
Families Have 24-Hour NICU Access
To help involve parents in their child’s care, the NICU offers 24-hour access, including overnight family rooms. This allows families to have 24-hour access to their newborns, as well as a place to rest. The unit also practices Kangaroo Care, a skin-to-skin care technique used to regulate an infant’s physiological and psychological warmth while increasing family bonding. Parents are also invited to attend monthly events and yearly celebrations to cultivate peer support.
To better serve families, the NICU team researched additional ways to involve parents in their child’s care. The team’s research led them to integrate family-centered care services into daily rounds made by clinicians.
“Family-centered care is a philosophy that encompasses the values and actions of the clinical team and recognizes the significance of the family in the care plan of their child,” shared Margi Bowers, NICU nurse manager. “Family-centered rounds are where we continue to develop the invaluable relationship between the parents and nurses through education and emotional support.”
Family-centered rounding was initially developed by a task force of physicians, bedside nurses, management, clinical specialists, and neonatal nurse practitioners. The task force met frequently to develop standards of work before piloting the model within the NICU.
The pilot launched at Women & Babies Hospital in November 2018 and was fully implemented by January 2019, receiving immediate praise from parents.
Each morning, family-centered rounds begin with each member of the care team introducing themselves, including the parents. Then, the bedside nurse reviews the 24-hour history of the infant.
The team then develops a plan of care for the day, while collecting input from the parents. The last detail includes the bedside nurse repeating the plan of care while simultaneously writing it on a dry erase board next to the infant’s bed.
“This new method of rounding is strategic and includes repetition of information, which has been proven helpful during high-stress situations. The dry erase board also provides a quick visual reminder for staff and parents throughout the day,” explained Bowers.
Through the pilot, the NICU team recognized and addressed additional opportunities for improvement, including parental involvement and the time it took to complete the rounds.
“While this new method of rounding is most beneficial when the infant’s parents are able to attend, we respect that each family is different and may not always have the ability to stay at the infant’s bedside.
This is why we implemented the dry erase boards,” said Bowers. “We have also worked together as a team to decrease the amount of time it takes to conduct rounds.”
By integrating family-centered rounds, the team has observed improved outcomes that are crucial for providing excellent patient care, including communication, care coordination and patient satisfaction.