Context Individualised care rooms (ICR) were established in District General Hospital with a Level 2 Neonatal Unit. This was a result of consultation between the medical health professionals, members of the allied health professionals and parent groups.
Problem In a traditional Neonatal Intensive Care (NICU) setting, the majority of care is undertaken by neonatal nurses and incubators are set out in an ‘open bay’ layout.
Assessment of problem and analysis of its causes As a result of this traditional setting, parents often report feeling disempowered. The lack of privacy also limits opportunities for kangaroo care and this can affect parent-child bonding.
In the Individualised Care Rooms (ICR) model, parents are encouraged to be resident alongside their premature baby from an early stage and become integral to their daily care in a developmental care environment. They are supported by doctors and nurses, and the babies are monitored by cardiac monitoring and pulse oximetry.
Research has shown that there is greater parents’ satisfaction with the ICR model and premature babies benefit from a shorter length of stay and lower incidence of bronchopulmonary dysplasia. Evidence also supports the provision of regular kangaroo care to improve cerebral function.
Intervention There are three broad phases:
First phase: Design and building of the ICR. We converted an area within our neonatal unit that was not in clinical use into 10 fully equipped individual rooms. Each room is designed specifically to allow adequate natural lighting, ventilation and space for an adult bed and an incubator. The rooms are also equipped with monitoring equipment and amenities including washbasin and television. Parents share bathrooms and dayroom facilities. A nursing station with central monitor is manned by trained neontal nurses to support parents and babies.
Second phase: Education and training. We formulated an admission policy and expected standard of care for the ICR. We set off to promote the ICR in a launch event. There is an ongoing programme of education and training sessions for health professionals and parent groups.
Third phase: Admission of babies to the ICR since December 2013.
Study design We are in the process of designing a pilot cohort analytical study comparing outcomes of premature babies in the ICR with matched controls of babies nursed in the open bay in our neonatal unit. Our primary outcome targets will include duration of stay, gestational age at discharge and weight at discharge. The secondary outcome target will be a formal neurodevelopmental assessment at various corrected gestation age timepoints.
Strategy for change The implementation of the ICR was carried out in a phased manner. This allows adequate time for specific consideration in the design and build of the rooms, education and training sessions, troubleshooting and lastly, implementation.
Measurement of improvement Alongside with the planned pilot cohot analytical study, we also plan to conduct a parent satisfaction survey to obtain formal feedback about the ICR.
Effects of changes Observation from health professionals are that babies are being discharged at a younger gestational age and lower birth weight with no significant unintended consequence in the community. Verbal feedback from the parent groups regarding ICR has been overwhelmingly positive so far. However we hope to produce a more formal and measurable outcome with the planned study and parents’ satisfaction survey.
Lessons learnt With the change of junior doctors every six months, education and training sessions need to be ongoing to promote awareness of the purpose and benefits of ICR. Ongoing troubleshooting sessions also help fine tune the running of ICR.
Message for others Based on current evidence, we believe that the ICR model should be taken into consideration in the future design and planning of any neonatal unit.
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