Communication in the NICU

From HMCwiki

Communication in the NICU has been facilitated by the Vermont-Oxford Network, a voluntary network of neonatal nurseries since 1989. With its purpose to track the outcome of very low birth weight infants (401 to 1500 g), this group has grown to 325 nurseries worldwide by 1999 and is one of the world's largest databases including information about the care and outcomes for high-risk infants treated in neonatal intensive care units.

Recently in their pilot Neonatal Intensive Care Quality Improvement Collaborative (NICQ), they started a new active collaboration to improve the effectiveness and efficiency of neonatal intensive care in 3 areas: clinical, operational, and organizational. Four key habits are being taught as written by nurses at Baylor University Medical Center (BUMC) and should be developed by all hospitals, especially those that want to become Magnet status care facilities.

The habit for change

The staff's open-minded ability to accept new ideas is the key to effective care. New ideas may come from many sources—e.g., the literature, an analysis of internal and external processes, benchmarking with superior performers, site visits to other NICUs, and researchers' own experience and thinking.^[1] The culture of the NICU, or any department for that matter, often will indicate whether the staff will or will not be resistant to change. A unit with a strong group culture will stress affiliation between staff members, teamwork, and participation; their culture will always be in a dynamic developmental phase that stresses risk taking and willingness to change. Even a largely hierarchical culture can be beneficial if it stresses establishment and maintenance of bureaucratic work patterns, a rational culture, and looks highly upon efficiency and achievement. Departments that have tight group and developmental cultures are considered receptive to quality improvement efforts.

The habit for understanding the processes of care

From entry to discharge, the multiple steps involved in providing care are often not appreciated. The formulation of a flow process chart can be very helpful in identifying problems. They also help to organize a plan of action and allow people from all parts of the process to see the larger picture. They realize why they are so valuable to the process as a whole. For example, to understand why hypocapneic ventilation was occurring in very low birth weight infants admitted to the NICU at Baylor University Medical Center (BUMC), their research team mapped the process of care in a flow chart. After educating the health care team about the importance of avoiding hypocapnia and the optimal way of selecting ventilator settings, the research group observed a significant decrease in variation of the first arterial PCO2 obtained after delivery.^[1]

The habit for collaborative learning

Through collaborating and networking with other departments with similar interests and carefully evaluating the care practices in better-performing NICUs through site visits, conferences and action forums, better practices are likely to be formulated. For hospitals, joining groups like the Healthcare Management Council, Inc. (HMC), one can join large nationwide community of hospitals with whom you can communicate with your peers at other hospitals through webcasts, conference calls, and surveys.

An example of networking deals with two focus groups formed at BUMC collaborated with other similar-minded groups among NICQ 2000 members. One focus group has concentrated on reducing nosocomial infection and has developed a potentially better practices work list. The other focus group has collaborated in developing strategies to reduce neonatal intraventricular hemorrhage and periventricular leukomalacia and also has produced a potentially better practices work list.^[1] Many of these practices will be implemented in each of the member NICUs after discussion with the local medical and nursing staff. Nevertheless, some practices that work well in certain nurseries may not work well in others, so it is important to thoughtfully apply new ideas in a culturally appropriate manner. Recognize that certain methods work with certain populations and environments.

The habit for using evidence-based practice

Evidence based medicine means finding the most efficacious interventions by carefully conducting research, evaluating practices through rigorous testing, and finding proper tools to assist physicians to make the right clinical decisions. For evidence based medicine to work, those using it must be flexible and ready to change their behavior and attitude in light of new findings.

In many NICUs, many of the routine practices have not been well tested or researched. Those interventions that have been subjected to randomized controlled trials need to be reviewed and, if appropriate, utilized in the NICU. Careful and critical evaluation and judicious application in one's own care practices may be very helpful in improving effectiveness of care.The conscientious, explicit, and judicious use of current best evidence in decision making.^[1]

Resources and references

1. ^ Whitfield, Jonathan. D. Charsha, P. Sprague. "In search of excellence—the Neonatal Intensive Care Quality Improvement Collaborative" Proc (Bayl Univ Med Cent). 2001 January; 14(1): 94–97. 2001. Baylor University Medical Center

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