Therapeutic hypothermia is initiated for neonates with moderate to severe hypoxic‐ischemic encephalopathy due to perinatal depression. Previously if an infant needed therapeutic hypothermia, they had to be transferred to another institution as this unit did not provide this service, causing a delay in care as the infant and mother become separated. One of the criteria for therapeutic hypothermia is to initiate body cooling within 6 hours of birth.

Collaboration between providers and staff occurred in order to bring therapeutic hypothermia to this NICU. Much time and energy were spent in creating protocols and educational materials to teach staff how to care for these fragile infants. This results in an enhanced outcome because the family unit does not have to be separated. Infants who are born less than 29 weeks gestational age are at increased risk for intraventricular hemorrhage (IVH) which can lead to developmental problems or cerebral palsy. In order to prevent IVH and additional sequela this team developed a protocol specific to these infants. This protocol includes things like two person cares, maintaining midline head positioning, and caution with diaper changes including not lifting hips higher than their head. In rolling out this protocol it has helped with developmental care and helped reduce the incidence of IVH. Overall, supporting these infants when they are most at risk enhances the quality of life for them and their families as they grow.

This unit’s feeding management committee worked to change our protocol on how infants learn to eat. They implemented infant-driven feeding (IDF) which is a program to advance the baby from tube feeding to oral feeding based on brain development. It prepares the family for long-term feeding success and prevents oral aversions. This program uses scales of success with a scoring system for infants’ readiness to feed and the quality of feeding. The team collaborated with physical and occupational therapy to roll out this program and provide formal education to staff. All education is also provided to parents before their infant begins to orally feed. The goal is to shorten the length of stay through faster time to full oral feedings, promoting higher quality outcomes. For infants who need extra time to learn to eat, this team worked together to develop a protocol for sending infants home with NG feeds, allowing them to thrive in their own environment with their own families. In order for this to happen, education was provided to staff and a guideline was created for parents to follow. When an infant is going home on NG feeds both parents have to competently show nurses how to put in an NG tube, secure the tube, and provide the NG tube feeding. By implementing IDF and NG feeds it promotes a positive experience for infants and parents ultimately advances the health and well‐being.

This unit did research on the prevention and reduction of bronchopulmonary dysplasia (BPD), which is a chronic lung disease that premature infants who need oxygen can develop. Infants with BPD can have long-term breathing difficulties and a higher risk for respiratory infections. In order to prevent BPD and the associated problems, this team rolled out staff education to initiate bubble CPAP in the delivery room. Prior to this, the providers would hold bag and mask until arriving in the NICU, therefore causing a delay in administering the most effective support. Collaboration between providers, nurses, and respiratory therapists was needed to achieve this goal of reducing BPD by utilizing noninvasive ventilation. Education was given to all staff in the simulation lab on how to set up and transfer a baby on bubble CPAP from the delivery room to the NICU. By initiating bubble CPAP in the delivery room, it helps prevent intubation and mechanical ventilation, which can lead to BPD.

This unit found that working as a team with all members helps to keep the parents involved and in their infant’s plan of care. Every day starting at 9:30 AM the providers, respiratory therapists, PT/OT, nurses, social worker, and dietitian conduct family‐centered rounds and go to each infant’s bedside to discuss the infant’s plan. Our unit encourages parents to attend as it is a great time for them to ask questions and advocate for their baby. All members of the team are encouraged to participate, ensuring that everyone is on the same page and that there is continuity of care. When the family is involved and active in the plan of care, this team is able to provide high-quality outcomes and improved satisfaction. When an infant is discharged from the unit the parents complete a discharge survey on an iPad before they leave that provides immediate feedback. This feedback is used to make improvements in the unit to further increased satisfaction and foster positive outcomes.