P2D128: Reducing Time to First Skin to Skin Care in Extremely Preterm Infants: An Interdisciplinary Quality Improvement Project

Purpose/Objectives: Positive parental touch (PPT) and skin to skin care (SSC) are neuroprotective strategies that provide benefits for both premature infants and their families. SSC supports physiologic stability, neurodevelopment, sleep protection and attenuates pain. In addition, SSC decreases stress and improves milk supply for mothers. Yet, NICU providers are often not comfortable promoting early SSC in the extremely preterm (EPT) population due to safety concerns such as inadvertent extubation (UPE) and intraventricular hemorrhage (IVH).
Aim
The SMART aim for this project is to increase PPT in EPT infants by 50% within 72 hours of life (HOL) by September, 2023. Early SSC both in non- intubated (within the first 72 HOL) and intubated infants (within first week of life, including those on first intention high frequency jet ventilation, HFJV), was identified as a key focus to accomplish this goal.

Design/Methods: This QI initiative was part of our participation in the California Perinatal Quality Care Collaborative (CPQCC) NEOBrain (NICUs Enabling Optimal Brain Health) which began in June 2022, and was set in a Level IV NICU averaging 60 EPT infants a year (born < 1000 g or < 28 weeks). Reducing time to first SSC was elected as a primary focus by the core interdisciplinary team composed of NICU nurses, respiratory therapists and led by a neonatologist and physical therapist. The core team worked through multiple PDSA cycles to educate staff using learning modules, practice skills workshops, targeted discussion during rounds, incentives in a “Kangaroo Raffle”, and visibility boards. Families were invited to provide feedback on their experience. Our unit policy on SSC was also updated.

Results: In the past nine months, PPT within the first 72 HOL improved by 30% (from 60% to 80%). The average time to first SSC prior to the collaborative was 184 HOL, with patient on HFJV not usually allowed to do SSC. During the active phase, SSC in intubated EPT infants is initiated by 123 HOL while in non-intubated EPT infant, it is 56 HOL. Severe IVH rate as a balancing measure, decreased from 17% to 14%. Only 1 infant had UPE.

Conclusion/Discussion: Implementing a QI initiative on early SSC in EPT infants reduced time to first SSC both in non-intubated and intubated infants. Using an interdisciplinary approach and different educational strategies allowed us to achieve our goal in a short period of time without worsening outcomes like severe IVH nor increased UPE rates. This interdisciplinary team effort is feasible and safe even for the smallest infants in the NICU, who along with their families, would benefit the most from SSC.