P2C026: A Quality Improvement Project - Providing Music Therapy to Premature Babies in the Neonatal Intensive Care Unit

Purpose/Objectives: The neonatal intensive care unit (NICU) exposes premature babies to unwanted, high-pitched sounds which are not physiologically aligned to a newborn’s audiological development. Although it is desirable to avoid the unwanted pathological noise level in the NICU, it is equally necessary to provide adequate positive auditory stimulation to the neonate. Music therapy (MT) can help bridge this gap. Music has been shown to decrease infants’ heart rates, stress, and salivary cortisol levels while improving nonnutritive sucking, oxygen saturation, and weight gain. In developing a MT program, the type, volume, and duration of music must be considered. Research has shown a link between exposure to the music of Mozart and improved cognition, mood, and decreased resting energy expenditure in neonates. Although live MT is preferred, recorded music can be effective as well. This quality improvement initiative was designed to provide premature babies admitted to the Children’s Hospital at Montefiore Jack D Weiler NICU with MT.
SMART

Aim: By June of 2023, 50% of eligible infants will receive MT during their hospitalization.

Design/Methods: A multidisciplinary team has been assembled to introduce MT to premature infants born < 32 weeks gestation. Qualifying infants are hemodynamically stable, on respiratory support of CPAP + 6 cm H20 and/or Fio2 30% or less, and on full enteral feeds. Recorded Mozart music is played by a speaker, 3 times per week for a 30-minute session at volume of 65 to 70 db. A sound meter is used to monitor volume and speakers kept at an appropriate distance from infant. A series of Plan-Do-Study-Act cycles were completed to 1. appropriately train the medical team in safe administration of MT, 2. streamline documentation of the intervention, and 3. develop reminders to maximize compliance. Feedback has been solicited from nurses and parents to further inform changes and optimizations to this project. Adherence and compliance to the MT protocol is being tracked on run charts

Results: This project was initiated in Dec 2022 and data has been collected for 4 months. On average, 8-12 infants qualify per month for MT. Our compliance to providing MT to any qualifying infant started at 50% and has steadily improved to 100% most recently (Fig 1). However, there has been variable compliance with the targeted number of sessions (3x per week), a measure which is still well below 50% each month (Fig 2).

Conclusion/Discussion: This is an ongoing project that has been well received upon implementation. Through multidisciplinary efforts, recorded MT can be effectively provided in the NICU. Interventions to improve compliance and expand inclusion criteria are ongoing.