1. Nov 2007 ACoRN © 2005-07 Support Baby, Family and Health Care Team

2. Nov 2007 ACoRN © 2005-07

3. Nov 2007 ACoRN © 2005-07 Support is integral to all aspects of ACoRN Provision of resuscitation, stabilization and care tasks.Provision of resuscitation, stabilization and care tasks. Provision of supportive care for the baby, family, and health care team.Provision of supportive care for the baby, family, and health care team.

4. Nov 2007 ACoRN © 2005-07

5. Nov 2007 ACoRN © 2005-07 Alerting signs Support of the baby involves monitoring and managing: Presence of distress or pain cuesPresence of distress or pain cues Uncontrolled environmental inputsUncontrolled environmental inputs –inadequate containment / positional support –excessive light or noise –excessive handling

6. Nov 2007 ACoRN © 2005-07 Pain and distress cues All newborns experience discomfort and painAll newborns experience discomfort and pain –these may have detrimental physiological consequences and may affect long term outcome Babies can communicate their tolerance of caregiving activities and their environment through non-verbal cuesBabies can communicate their tolerance of caregiving activities and their environment through non-verbal cues

7. Nov 2007 ACoRN © 2005-07 Behavioral signs –state change –facial expression –muscle tone –body movement –skin colour Even babies who are extremely preterm perceive pain.Even babies who are extremely preterm perceive pain. Signs of pain can vary depending on the baby’s gestational age and status.Signs of pain can vary depending on the baby’s gestational age and status. Physiological signs –increased: heart rate, respiratory rate, blood pressure, palmar sweating –decreased: oxygen saturation, heart rate variability, irregular respiratory rate, skin temperature Pain and distress cues

8. Nov 2007 ACoRN © 2005-07 Pain and distress cues

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12. Nov 2007 ACoRN © 2005-07 Environmental inputs Uncontrolled, excessive environmental light, noise, and other stimuli are not tolerated by newborns.Uncontrolled, excessive environmental light, noise, and other stimuli are not tolerated by newborns. –these may have detrimental physiological consequences and may affect long term outcome Minimizing extraneous stimulation and attending to distress cues reduces morbidity and length of hospital stay.Minimizing extraneous stimulation and attending to distress cues reduces morbidity and length of hospital stay.

13. Nov 2007 ACoRN © 2005-07 Core Steps Minimize noise levelsMinimize noise levels Pace care interventions as much as possible, allowing for recovery timePace care interventions as much as possible, allowing for recovery time Minimize light levels as soon as possible, as allowed by monitoring availableMinimize light levels as soon as possible, as allowed by monitoring available Contain babies arms and legs by building a “nest” with soft cloth materialContain babies arms and legs by building a “nest” with soft cloth material Provide a sootherProvide a soother Observe for cues of distress or painObserve for cues of distress or pain

14. Nov 2007 ACoRN © 2005-07 Organization of Care Tasks SupportiveEnvironment ` Baby

15. Nov 2007 ACoRN © 2005-07 Response Consider the use of pharmacologic sedation and analgesia :Consider the use of pharmacologic sedation and analgesia : – after using non-pharmacologic strategies to minimize a baby’s discomfort, and –the baby continues to show signs of distress or pain, or –unpaced care is needed to stabilize the clinical condition Morphine is the most commonly used analgesic in neonatal care.Morphine is the most commonly used analgesic in neonatal care.

16. Nov 2007 ACoRN © 2005-07 The baby is lying on a radiant warmer in the brightly-lit nursery. There are loud voices in the background and the overbed heater alarm is ringing.The baby is lying on a radiant warmer in the brightly-lit nursery. There are loud voices in the background and the overbed heater alarm is ringing. The baby startles while vitamin K and erythromycin ointment are administered. A capillary blood gas and glucose are drawn via heel poke. He cries throughout the procedure. An IV is started after four attempts.The baby startles while vitamin K and erythromycin ointment are administered. A capillary blood gas and glucose are drawn via heel poke. He cries throughout the procedure. An IV is started after four attempts. Case study

17. Nov 2007 ACoRN © 2005-07 The physician returns for an update and you exchange information across the warmer.The physician returns for an update and you exchange information across the warmer. The baby now looks exhausted. His respiratory distress is worsening and oxygen requirements have increased to 55%. His eyes are closed but he startles, flails his arms and legs, grimaces, and cries each time he is handled or hears loud noises.The baby now looks exhausted. His respiratory distress is worsening and oxygen requirements have increased to 55%. His eyes are closed but he startles, flails his arms and legs, grimaces, and cries each time he is handled or hears loud noises. While he is being positioned for a chest film, he stops breathing and becomes bradycardic……..While he is being positioned for a chest film, he stops breathing and becomes bradycardic…….. Case study

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20. Nov 2007 ACoRN © 2005-07 The baby is lying on a radiant warmer in the brightly lit nursery. There are quiet voices in the background and the overhead heater alarm is silenced promptly.The baby is lying on a radiant warmer in the brightly lit nursery. There are quiet voices in the background and the overhead heater alarm is silenced promptly. You gently flex the baby’s limbs and position a U-shaped nest around him to help contain his arms and legs. He squirms slightly, splays his fingers, and pushes against the sides of the nest with his feet. The boundaries of the nest contain the baby’s arms and legs.You gently flex the baby’s limbs and position a U-shaped nest around him to help contain his arms and legs. He squirms slightly, splays his fingers, and pushes against the sides of the nest with his feet. The boundaries of the nest contain the baby’s arms and legs. Case study – A different approach

21. Nov 2007 ACoRN © 2005-07 You place your hands on the baby to settle him and help him maintain a quiet state before beginning your assessment. You talk softly as you pace your care according to the baby’s behavioural cues, giving him time to recover when necessary. You prefer to do one intervention at a time to avoid overwhelming him.You place your hands on the baby to settle him and help him maintain a quiet state before beginning your assessment. You talk softly as you pace your care according to the baby’s behavioural cues, giving him time to recover when necessary. You prefer to do one intervention at a time to avoid overwhelming him. On arrival of the physician, the two of you move away from the radiant warmer and engage in quiet discussion.On arrival of the physician, the two of you move away from the radiant warmer and engage in quiet discussion. Case study – A different approach

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24. Nov 2007 ACoRN © 2005-07 Supporting the family is an integral part of caring for the baby.Supporting the family is an integral part of caring for the baby. A baby who requires transport to another facility represents an additional source of stress over and above the stress of an ill baby.A baby who requires transport to another facility represents an additional source of stress over and above the stress of an ill baby. Next Steps

25. Nov 2007 ACoRN © 2005-07 Next Steps Supporting the family includes:Supporting the family includes: –allowing the parents to be present during resuscitation and stabilization –be realistic when explaining the course of care and possible outcomes –as soon and as much as possible, bring them in to see, touch and talk to their baby –help them understand the level of care their baby needs by explaining it as they visit –focus on their baby rather than the technology –provide parents with a photograph of their baby –ask the parents what they need or want to help cope with this event

26. Nov 2007 ACoRN © 2005-07 Next Steps Supporting the Team resuscitation and stabilization are a team effortresuscitation and stabilization are a team effort high intensity interventions and critical illness in a baby can result in feelings of distress amongst team membershigh intensity interventions and critical illness in a baby can result in feelings of distress amongst team members important to recognize signs of distress amongst team members in order to:important to recognize signs of distress amongst team members in order to: –prevent burnout –improve/maintain a high level of performance

27. Nov 2007 ACoRN © 2005-07 Next Steps Every clinical experience should be recognized as an opportunity to reflect.Every clinical experience should be recognized as an opportunity to reflect. Routine case reviews build confidence, improve team functioning, and generate ideas to improve policies, procedures, and training.Routine case reviews build confidence, improve team functioning, and generate ideas to improve policies, procedures, and training. The use of the ACoRN Process and Sequences to review the clinical experience provides a structure for case reviews.The use of the ACoRN Process and Sequences to review the clinical experience provides a structure for case reviews.

28. Nov 2007 ACoRN © 2005-07 Template for case review A nticipation/preparation Personnel Supplies and equipment C ommunication Between team members Between teams With family members O bjective assessment of care As per ACoRN framework and sequences R ecommendations Equipment and supplies Current policies and procedures Communication Staff education/skill maintenance N ext: check completion of tasks

29. Nov 2007 ACoRN © 2005-07 Palliative Care Palliative care is when you: move from active care to save a baby’s life, tomove from active care to save a baby’s life, to active care to provide comfort care to the baby, family and health care team as the baby dies.active care to provide comfort care to the baby, family and health care team as the baby dies. During the difficult time surrounding the death of a baby, the family’s and health care team’s needs should be supported.

30. Nov 2007 ACoRN © 2005-07 Questions??