1. Micropreemie 4 Homeroom
Rationale / Background
Nurses have provided most of the care during admission
Parents have participated in care closer to discharge
This care model does not support best outcomes
Parent/Family Integrated Care is the effective model
Family Integrated Care (FIC): Improving Communication in the NICU
St. Joseph Medical Center, Tacoma, WA
Kim Deynaka, MBA, BS, RNC; Victoria Trinh, MSN (c), BS, RN
Achieving Measurable Improvement for Infants and Families
Micropreemie 4 Homeroom
Surprises and Challenges
Unexpected Gained Insights: Staff overcame environmental constraints and change in their work routine to support different work for potentially better practices.
Culture Revelations: SJMC bedside nurses are change pioneers that drive improvement in care and work flow. Change is never easy, but they are willing to improve and adapt to support best outcomes based in evidence.
Family-Centered Care at SJMC: Family-centered care is subconsciously done by many nurses already, what isn’t done is streamlining and standardizing the language of family-centered care so that it is consistent and cohesive.
Teamwork at SJMC: SJMC nurses support one another – education is provided to newer nurses when there is a gap in understanding, clarification is sought when needed, and critical thinking is supported to improve practice.
Challenges & How They Were Addressed: Initial push-back of “more work” that is “already done”. This was addressed through providing a rationale and evidence to support the QI project, which many nurses acknowledged as a need for change. Furthermore, leadership found that rounding varied from person-to-person, thus we are currently working on a standardized audit tool.
Hierarchy of Aims
Global Aim: Family integrated care in the NICU by December 31, 2019
Improvement Project Aim: By August 31, 2019, communication between staff and with parents will improve. This will be measured by a decrease in frequency of safety crosses (failure incidences) related to communication from 50-60% to 40-30%
Communication improves safety, patient outcomes, parent experience, and supports family integrated care
Key Driver Diagram
PDSA 1
Bedside Report
PDSA 3
Parent Care Board
PDSA 2
Rounding Script
Hypothesized Data
Mapping Current Process Revealed
Team Acknowledgements
Perinatal Quality Improvement Oversight Committee, Family Integrated Care Committee, Parent Advisory Team, SJMC NICU Department
Sandi Britton, Kei Corbett, Olivia Fragoso, Craig Hillborn, Kaetlyn Hughes, Mari Johnson, Jesse Kasten, Kim Gustafason, Brianna Payne, Karen Pizzutello, Debbie Raniero, Jenica Sandall, Celeste Tufts, Stephen Welty, Lindsay White
We Would Appreciate Your Help With
Implementation of changes in the rounding script – changes to include parents in the script have not been fully accepted and implemented. Suggestions on how to support and assure staff that the changes will improve outcomes and work flow would be much appreciate.
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Family-Centered Care – under development
Unit walk-about revealed high parent satisfaction scores and positive feedback with NICU experience, despite inconsistencies in care and potential for better practices
Parent Advisory Team provided feedback that supported quality improvement and change ideas
Teamwork – under development
Share at least one test of change / implementation that resulted from your unit’s use of the Psychological Safety Rounding Tool or other project (bullet text 24 pt minimum)
Parent perception of rounds after roll-out of the communication bundle greatly improved. They felt important and viewed rounds as a time to communicate with the care team
Parent care board and scripted rounds made parents feel like their voices were heard
Tests of Change
PDSA Cycle 1
Bedside report including parents (in person / phone)
What we learned: nurses report order of script is not efficient
Next test will include modification of order for beside report
PDSA Cycle 2
Use of rounding script to advance consistency of information communicated with families
What we learned: inconsistent use of script; perceived as extra work
Next test will be preceded by education; unit leaders will support use of rounding script
PDSA Cycle 3
Introduction of parent care board
What we learned: parents were not always aware of the board and how it could be used
Next test will include parent orientation to care board
Bedside Shift Report Script
Nurses supporting one another in standardized handoff using HOMME
Accountability to ensure safety during handoff
Nurses championing change
Rounding Script
Care team supporting and educating parents about their role in rounds
Parents feeling like they are an important and integral part of the team
Discussing discharge and care as a team H O M E
History
Orders
Medications
Milk
Expectations