An NICU infant stress reduction QI team: applying research findings to clinical care.
BACKGROUND
In 1992 the 29-bed, Level III neonatal intensive care unit (NICU) at White Memorial Medical Center in Los Angeles discovered that nursing care strategies designed to support the normal development of premature infants, as suggested by research findings, were often inconsistent with existing policies, protocols, and physician preferences.
In 1993 a QI team set out to recommend changes in patient care which would reduce newborns' stress in the NICU. Given the complexity of neonatal care and the diversity of team members' professional training, the hospital contracted with a psychologist to present a two-day NICU training program that emphasized the application of current research findings regarding the physiologic and developmental effects (that is, complications) of stressors on infants.
Changes in care required negotiations with the physicians and directors of affected departments, extensive rewriting of policies, clinical evaluations, requests of additional supplies, and comprehensive staff training. Changes were made in the NICU environment (for example, light and noise reductions), NICU admission process (for example, placing of umbilical arterial lines, flexed positioning of infant extremities, thermal stress), developmental care (for example, the infant's need for soothing, ability for social interaction), and suctioning procedures (for example, suctioning and lavaging only when the infant is symptomatic rather than on a preset schedule, keeping the infant's head midline instead of turning it from side to side).


RESULTS
Improvement in a six-month period following implementation of the team's recommendations were identified, supporting the initial hypothesis that redesigning procedures and care protocols could reduce the stress of the patients in the NICU.
Floyd
A M
AM
Pediatric and Neonatal Service, White Memorial Medical Center, Los Angeles 90033-2462, USA.
D003625:Data Collection; D005190:Family / Q000523:psychology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007318:Inservice Training; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D015141:Los Angeles; D008332:Management Quality Circles; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011050:Policy Making; D013312:Stress, Physiological / Q000451:nursing* / Q000517:prevention & control