2016 MOREOB Patient Safety Award Winner
Improving the quality and safety of care to our patients in the Family Birthing Centre (FBC) at Windsor Regional Hospital is our number one priority. Over the last 11 years, our multidisciplinary core team has remained dedicated to the principles of MOREOB. We have used these concepts to employ innovative ideas to support and promote the safety and well being of every patient.
Our FBC has done an outstanding job implementing immediate skin to skin with the mother baby unit for the first two hours after birth. This intervention has shown an increase in breastfeeding initiation and a decrease in initial NICU admissions for transitioning babies. Dr. Guy Paul Gagne gave our core team an excellent presentation on the long-term cognitive/neurodevelopmental benefits of ongoing skin-to-skin for the first year of life. We recognized that skin-to-skin contact beyond the first two hours was variably implemented on our unit and focused solely on breastfeeding mothers. Due to the well-documented long-term benefits of skin-to skin, our core team identified the need for continued skin-to-skin as a patient safety
initiative. Our goal was clear: every mother and baby would participate in a minimum of one hour of uninterrupted skin-to-skin daily during their hospital stay to facilitate bonding, normalize maternal and infant vital signs in the early transition period,
assist in establishing breastfeeding and decrease supplementation rates. Education for parents about the long term cognitive/neurodevel opmental benefit of skin-to-skin for all babies in the first year of life was initiated on hospital admission and emphasized throughout their postpartum stay.
Our main objectives were to:
- Identify maternal benefits of skin-to-skin
- Identify fetal benefits of skin-to-skin
- Recognize the importance of skin-to-skin at birth and continued skin-to-skin contact for one year
- Develop a care plan to incorporate daily quiet time in hospital for the mother, partner and baby to rest, bond, heal and hold their babies skin-to-skin
- Develop a teaching plan to educate parents on the benefits of continued skin to-skin beyond their hospital stay regardless of feeding method
- Increase patient satisfaction and emotional support on our NRC Picker scores
- Decrease supplementation rates at hospital discharge in patients who planned to exclusively breastfeed on admission
Hoping to positively impact the mother, baby and significant other, members of the multidisciplinary team included: nurses, clinical practice managers, physicians, and hospital support staff (lab, dietary, audiology, housekeeping, unit aides, ward clerks). Success was measured through patient feedback during leadership rounding by clinical practice managers as well as supplementation audits, BORN data, and our hospital obtained patient satisfaction survey (NRC Picker).
Key strategies for success included involvement and education for the patients during the antenatal period and education for front-line staff within the FBC starting in March 2016. Quiet time posters were placed in the OB/GYN office wailing rooms, OB triage and all patient rooms. Information about quiet time was posted on a popular local "All 4 Mamas" Facebook page.
Main body of submission:
April 4, 2016 marked the start of our quiet time initiative. Front-line healthcare providers implemented the benefits of skin to skin health teaching on admission and re-enforced the concept during the hospital stay. Pink signs were hung in the patient room doorways during quiet time as a reminder to staff, visitors, support staff and patients following the quiet time announcement made 15 minutes prior to the scheduled hour:
"Attention all patients. We will be having quiet time from 2:45-3:45. This time is one hour for the new mother, significant other and newborn to rest, bond, heal and hold their baby skin to skin. We would appreciate if all visitors waited in the waiting room or cafeteria during this time. Thank you."
During this one hour period nursing call announcements are limited to an emergency basis, and no scheduled lab draws, hearing or other testing is completed. T-shirts with a mother holding a baby on the front staling, "Quiet Time is Your Time" and
"Ask Me about Quiet Time" on the back to prompt discussion were created for staff. The main doors to the unit are closed with a sign directing visitors to stop at the desk prior to entering a patient room. Ultimately it is the patient's choice to participate which can be facilitated as our post partum patients all have private rooms.
The MOREOB HRO principles utilized include: operations are a team effort, safety is the priority and everyone's responsibility and communication is highly valued. The new MOREOB chapter on breastfeeding was a vital component in our 2016 workshop to re-enforce the importance of promoting skin-to-skin as a standard of care. Audits were performed to track breastfeeding and supplementation rates as reported in our provincial BORN data.
Our director and clinical practice managers were supportive and paramount in obtaining patient feedback on leadership rounding as well as educating and reminding staff to "talk up" quiet time at the beginning of their shift. Our senior leadership and core team were pivotal in reporting our progress and successes at weekly staff meetings, through global staff email, core team meetings, and our MOREOB workshop. Quiet time was discussed at newborn care committee meetings involving, neonatology, social work, dieticians, paediatrics, nurse practitioners, midwives and laboratory services. We also collaborated with our NICU to promote their 'Kangaroo Care-a-thon' that took place May 2nd to15th, 2016.
During leadership rounding patients are asked if they knew about quiet time prior to their hospital admission and if they took advantage of this time during their slay.
Patient responses included:
- "I didn't know about quiet time prior to coming lo the hospital but appreciated education by nurses and loved the time to spend as a family postpartum"
- "I had heard about quiet time prior to my stay from a friend who had recently had a baby"
- "I wasn't aware of quiet time but I loved it and it gave me an excuse lo make my visitors leave"
- "The postpartum period is so short and overwhelming, I loved knowing that my family would have to leave for one hour"
- "I saw the quiet time poster in my physicians' office during my appointments and I made a point to let my family and friends know before I had the baby" "'I didn't know about quiet time but I'm planning on taking advantage of it today"
- From an RN caring for a family "I educated the family on quiet time following their early morning delivery of their first child and they seemed unsure of the benefits. When I visited them the following day they said they were so grateful for quiet time and loved the time they got to spend as their new family. They were planning on implementing a quiet time period once they went home in hopes of getting the rest they needed."
Quiet time has also shown to benefit the staff in giving them time to reorganize their shift Staff have expressed that patients are satisfied with the "excuse" lo have visitors leave and there is an increase in knowledge for all healthcare professionals on the benefits of breastfeeding and continued skin-lo-skin.
Prior to the initiation of quiet time, BORN reported our rate of supplementation at discharge in term infants whose mothers intended to breastfeed at 26% (red indicator). During our implementation month, April, our supplementation rates decreased slightly to 25.2%. One month following the implementation of quiet time we were at 22.7% (yellow indicator). Since implementation our supplementation rates have not increased beyond our pre-intervention percentage and the core team is optimistic that we will reach our goal of less than 20% within one year. Results from our hospital patient satisfaction survey (NRC Picker) demonstrated an increase in patient emotional support from 69-74% and an increase in overall patient satisfaction from 90-94% in April - October 2015 lo 2016.
Through inter-professional collaboration and an emphasis on the MOREOB principles of patient safely, teamwork and communication our Family Birthing Centre has effectively implemented quiet time and subsequently increased patient satisfaction. Measures of patient satisfaction and supplementation rates will continue to be tracked through leadership rounding, BORN data and NRC Picker. Our core team is committed to the continuation of quiet time and encourages other birthing centres to implement quiet time as standard of care to promote ongoing skin-lo-skin.