Jane Grassley PhD RN IBCLC Judy Jones MSN RN NEABC Idaho Perinatal Project Presentation 2014 FAMILY CENTERED CESAREAN BIRTH Introduction The mission of SLRMC LampD is to provide exceptional compassionate and individualized patient care to the pregnant women and famili ID: 183581
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Skin-to-skin after cesarean
Jane Grassley PhD, RN, IBCLCJudy Jones, MSN, RN, NEA-BCIdaho Perinatal Project Presentation -2014
FAMILY CENTERED CESAREAN BIRTH Slide2
Introduction
The mission of SLRMC L&D is: “… to provide exceptional, compassionate, and individualized patient care to the pregnant women and families of our region.”
St. Luke’s Health System, 2012Slide3
Overview
Our project was to pilot skin to skin care for moms and babies experiencing scheduled cesarean births in expectation that this will eventually improve exclusive breastfeeding ratesSlide4Slide5
Leading Change Framework
J. Skeleton-Green, B. Simpson and J. Scott (2007)Slide6
Approach
J and J approached unit leadership for L&D and NICU, physician from one group for pilot, and chief of OB anesthesiaKey staff were identified from L&D, NICU and a CRNA from AnesthesiaJJ presented at OB Supervisory and MD-RN collaborative JG’s senior nursing students were invaluable to the processSlide7
Approach
Adopted JHNEBP model, consistent with hospitalRequires planning, evidence, and translationP phase – using PICO approach, identified practice issues: identify barriers and facilitators(O) to offering skin to skin care in the OR for at least 15 minutes (I) to mothers and newborns after uncomplicated cesarean birth(P)Slide8
Approach (cont’d)
Used the power of simulationWorked through processSimulation in the OR itselfVideo of simulation once process identifiedPilot to continue up to 3 months and involve about 40-50 moms from single clinic experiencing scheduled, uncomplicated cesareanSlide9
Approach
Education of all staff who might participate in scheduled cesarean from L&D and NICU; one page summary for CRNAs since unable to attendVideo simulation provided as adjunct to staff education Pilot ran from January to mid-March, 2013Slide10
Education module for employees
Describes roles of healthcare providers
Addresses questions & concernsSlide11
Parent Flyer
Addresses what skin-to-skin is
What to expect
Benefits for mother and infantSlide12
Results
SSC offered to moms of pilot clinic per criteria by L&D RN on admissionIf yes, surgical team informed at surgical pausePilot completed at 2 ½ months with 44 familiesResults were compiled by either L&D or NICU RN completion of the outcomes form.11%(5) declined43%(19) held their infants at least 15 minutes37%(16) held newborns less than 15 minutes Slide13
Results (cont’d)
9% were unable due to a newborn or maternal condition – newborn size, stability, nausea Short length of surgery contributed to minimal time for SSC87% of nurses responded that they felt knowledgeable of processPositive patient feedback reinforced the experience for staff involvedSlide14
Results (cont’d)
Parent comments included: “I wasn’t able to do this with my other 2 Csections” “It was really nice; my last baby I did not see for half an hour” Patient was thrilled; position was comfortable; baby nestled in neck; Mom stated “baby didn’t mind at all”
Dads were also enthusiastic although it was mom that we asked to consent. Slide15
Follow up
Pilot discontinued in mid-MarchResults reported at OB Dept, MD-RN collaborative, and to CNOLetter to physicians offering this well received approach to patients scheduled for uncomplicated repeat cesareanHardwiring aided by providing documentation opportunity in EHRSlide16
Implementation Recommendations
1. Evaluate staff knowledge of skin-to-skin.2. Educate L&D and NICU/Nursery staff who attend cesarean births. Include physicians’ office to involve their staff with further information about the skin-to-skin process.Slide17
3. Encourage physicians/office nurses to educate patients about skin-to-skin as an option following cesarean births.
4. Evaluate patient satisfaction with skin-to-skin.Recommendations (cont.)Slide18
Recommendations (cont.)
Consider the creation of a policy change to include skin-to-skin as standard protocol.Encourage documentation of the occurrence of skin-to-skin following cesarean births.Slide19
Recommendations (cont.)
7. Identify RN liaisons, one in L&D and another in NICU, to address staff and patient/family questions and concerns about skin-to-skin.8. Disseminate approach and project results with delivering hospitals.Slide20
Special Thanks to:
Senior nursing students who drafted our education, scripted and taped our simulation, and made this project easy to do!BOISE STATE UNIVERSITY SCHOOL OF NURSINGCLASS OF 2012
Samantha Byrnes, Lorinda Coombs, Rachel Finnell, Patricia Jones, Angelica Kovach, Jenna Lindsay, Monika Ryan, Shelley Sinclair, Caitlin Sitz, Caroline Strong, Caitlyn UhnakSlide21
Special Thank You
SLRMC L&D
SLRMC NICUJane Kornfield
Donna
SwirczynskiSlide22
Thank you!