Context The improvement work was done in a neonatal unit inUK. It involved improvement in the care of newborns and included feedback from parents.
Problem The survey was done to assess parent’s experiences of neonatal services, identify problems and get an understanding of how the quality of care can be improved. This helped us in developing a culture of continuous improvement that involves and is informed by parents, maintains high quality care for babies and their families and encourages the unit to continually raise the bar in provision of family-centred care.
Study design A questionnaire was sent to parents whose babies were discharged home over 4 months from December 2013 to March 2014. Parents were ineligible for inclusion if the care of the baby was re-oriented, if the baby had been taken into care or discharged to a post-natal ward. The Patient list was identified from Badger net. A Questionnaire and letter of introduction was prepared in consultation with medical and nursing staff. The questionnaire was sent by post once the baby had been discharged. Parents were reminded by phone a week later. Responses were returned to the neonatal secretaries by post.
Assessment of problem and analysis of its causes It was encouraging to see parents reporting positive experiences. There were problems which were identified from the feedback. The problems identified were parents were given inconsistent feeding plans and strategies from nursing staff, majority of parents of babies transferred to or from the unit felt the need to be with their baby during transfer, parents are asked to leave the ward during ward rounds to protect other babies’ confidentiality and then usually relied on the nurses for feed back, it was felt by parents that the unit was outdated, overcrowded and stressful – “not fit for purpose” and parents coming from outside the city felt the need for a day room and space for families. This will encourage their involvement in the care of their babies.
Strategy for change New NHS trust infant feeding policy and guidelines were formulated. Nursing staff were trained in regard to the policy. There is a need for a full-time breast feeding nurse, If possible, parents will accompany their baby on transfers, an improvement tree was placed in the unit for parents. This is easy to access and will help parents to comment on their experience and offer suggestions, parents will be encouraged to remain with their baby during ward rounds. This will help to involve them in the care of their baby and to update them, parents of babies who are likely to be in the unit for a prolonged time will also be given weekly updates by senior medical staff and plans for a new Women’s hospital (2020) are underway and a parent focus group will be involved in the project to ensure their needs are met.
Measurement of improvement The survey will be repeated to see the effect of changes in strategy. Outcomes which have been encouraging have also been monitored by monitoring feeding policy and breastfeeding rates through Badger net and positive feedback from parent comments on the improvement tree.
Lessons learnt and message for others Most parents would like to be present during ward rounds; an opportunity to be updated by medical and nursing staff and allows them to be more involved in the day to day care of their baby; an improvement tree is a good way of getting feedback on a regular basis; Neonatal unit is a stressful environment and parents would benefit from a Day room and where possible, parents should be transported with their babies.
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