Tamara Bledsoe, MS, NNP, APRN-BC-C-ONQS, Vargabi Ghei, MD, MSHS, Pamela Torreblanca, RN

The Family-Centered Care Taskforce stands as a pioneering force, being the FIRST international, multicenter, collaborative initiative solely dedicated to quality improvement in family-centered care. The task force employs a small group model with monthly office hours and a large group model with bi-monthly webinars, enabling effective communication and facilitating change across various healthcare settings. By sharing evidence-based practices and critical family perspectives during webinars and by promoting accountability through small groups, we are creating a forward movement to close the healthcare gap. Our 13th webinar, which took place March 14th, was sponsored by Draeger, whose mission is ‘Care for babies like never before,’ and Reckitt/Mead Johnson, who ‘Protect, heal and nurture in the pursuit of a healthier world.’ Our webinar speakers share their skin-to-skin and family-centered care practices in the FCC column below. Find a complete recording and accompanying resources at no cost at www.fcctaskforce.org, and subscribe to receive future Zoom calendar invites for our free educational webinars.

In their talk, entitled “Improving Skin-to-Skin and Family Centered Care in a Community Level 3 NICU,” Vargabi, Tamara, and Pamela discussed how their Level III NICU at HCA Northwest Medical Center improved their time to first episode of skin-to-skin care and their staff’s perception of family-centered care. In 2021 and 2022, they faced several barriers, including low parental presence at the bedside due to COVID-19 pandemic policies that limited parental visitation and a lack of standardization regarding skin-to-skin care. In general, there was a lot of fear and anxiety around skin-to-skin care, especially with infants who were intubated or had central lines. Staff felt they had not received enough education about skin-to-skin with such patients and were unsure they could safely help caregivers perform skin-to-skin in these situations. 

In 2022, our NICU joined the Florida Perinatal Quality Collaborative’s (FPQC) PAIRED initiative. The primary goal of this initiative was to decrease the time to the first episode of skin-to-skin care by a baseline of 20% (see Figure 1 Key Driver Diagram). The unit also aimed to make the care in their unit more family-centered. The HCA Northwest NICU formed an interdisciplinary team of three nurses, three neonatologists, a hospital leader, a data champion, and a respiratory therapist. Their main interventions (figure 2) included performing simulations of transfers of intubated small babies who had central lines to caregivers. They also provided caregiver education through distributing a brochure on the benefits of skin-to-skin care to parents upon admission. The team hung signs in the NICU reminding parents to ask to do skin-to-skin care with their infants, creating an excellent opportunity for advocacy. Lastly, they created an official skin-to-skin policy for staff in the unit to reference. 

Regarding advancing family-centered care, HCA Northwest NICU started to include parents on rounds via phone when they could not be present in person. Since they did not have a Family Advisory Council, they offered parents the opportunity to receive peer support through Hand-to-Hold. The FPQC provided monthly coaching calls, ongoing feedback, and guidance on the NICU’s data. 

HCA Northwest reduced their average time to first hold from 7 days to 2.8 days. By completing this initiative, they rose from roughly the 45th percentile to about the 90th percentile for prompt initiation of skin-to-skin care among all of the NICUs participating in the initiative. Based on feedback from staff, the NICU’s care also became more family-centered. They mentioned that it was no longer uncommon for intubated patients to do skin-to-skin care, that parents were now asking for skin-to-skin care more often, and found great comfort in having an official skin-to-skin policy to reference. 

Overall, this is just the beginning of the journey towards improving skin-to-skin and family-centered care at HCA Northwest. Future directions include eventually forming a Family Advisory Council and, of course, holding many more Kangaroo-A-Thons!