385 - Using Quality Improvement to Increase Early Skin to Skin Care in Preterm Infants

Poster Number: 385
Publication Number: 385.434

Katherine Coughlin, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, United States; Jenny Koo, University of California, San Diego School of Medicine, San Diego, CA, United States; David Kaegi, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, United States; Rachelle Sey, Sharp Mary Birch Hospital for Women & Newborns, Santee, CA, United States

Background: Skin to skin care (STS) for preterm infants improves weight gain, vital sign stability, breastmilk production, and rates of breastfeeding at discharge. It improves parental bonding while decreasing stress and possibly reduces late onset infection and mortality. Despite known benefits, executing STS in preterm neonates is challenging and often delayed. At Sharp Mary Birch Hospital for Women and Newborns (SMBHWN), an 84 bed, level III unit, the average day of first STS for preterm infants born less than 29 weeks’ GA was 14 days of life. Stratifying by ethnicity, infants with Hispanic mothers held later than other combined ethnicities (median of 12.3 vs 11.3 days).

Objective: The primary objective was to decrease the day of first skin to skin care from 14 to 7 days in infants born less than 29 weeks’ GA at SMBHWN by January, 2022. A secondary objective was to eliminate the disparity based on ethnicity.

Design/Methods: A multidisciplinary QI team including nurses, physicians, respiratory therapists, social workers, and physical therapists used the model for improvement. At project start there were no guidelines for STS. A survey of bedside staff identified barriers and facilitators to STS and a survey of physicians helped define eligibility criteria. PDSA cycles included drafting a protocol and bedside checklist, parent handouts, appointments for higher risk infants, creation of training videos and staff education modules, and eventually expanding eligibility criteria with a track record of safety. Measures were tracked longitudinally using statistical process control (SPC) charts and run charts.

Results: Baseline data collection started in July, 2019 and data through December, 2021 includes 216 infants born < 29 weeks’ GA. The primary outcome measure of days to first skin to skin decreased from 14.3 days to 7.1 days on SPC X Bar & S chart (Figure 1). Our process measure stratifying days to first STS by race and ethnicity is trending towards elimination of the disparity with an anticipated median shift on run chart next quarter (Figure 2). The additional process measure of percent eligible infants held has a mean of 93% on SPC P chart (Figure 3).Conclusion(s): Using quality improvement methods, we reduced the days to first STS in our preterm infants by 50%, a significant shift on SPC chart. Through standardization, improved awareness, and targeted interventions, we are also decreasing the identified disparity in our Hispanic families.
Figure 1. X Bar Chart - Days to First Skin to Skin in Infants < 29 WeeksSlide1.jpegMean decreased from 14.3 days to 7.1 days.
Figure 2. P Chart - Percent of Eligible Infants Held in the First WeekSlide2.jpegMean of 93% of eligible infants held since project start.