Abstract
Background: There is a significant early bonding and participation deficiency between the parents or family and their medically complex infants in the NICU. The literature included a variety of surveys and interventions to aid families with a bonding deficit and monitor families for the risk of lack of bonding/engagement. Parental engagement with their infant’s care is a way to enhance the maternal-infant bond.|Purpose: The purpose of this quality improvement project was to increase participation and engagement for the parents of medically complex infants prior to discharge. This project will allow discharges to be more timely, without the need to extend a discharge date or incur a readmission due to parental incompetence and/or lack of confidence.|Methods: The project included 15 participants. Infants who were included in this project had a high risk for being discharged with complex medical equipment or medical diagnoses. These infants were identified as: 1) infants greater than 60 days of life and still requiring CPAP greater than +5 cm of water pressure; 2) infants who had abdominal surgery and were without their ileocecal valve; 3) infants greater than 42 weeks corrected gestation and still not eating more than 40% of their daily meals by mouth; 4) infants born less than or equal to 1000 grams at birth. The outcomes were: 1) number of parental participation events weekly, 2) number of visits families make to the unit per week, and 3) the number of prescheduled visits the families made that are placed on the monthly calendar in advance and parents arrived at the scheduled time.|Results: There was a 15% increase in parent participation events. The parent participation scores over time increased from a 1.0 during the first two weeks to a score of 5.0 over the last four weeks of the data collection period. Appointments made and kept were 42%. The total visitation percentage from the families was 65%. The total participation form usage by nurses was 23%.|Conclusions: This QI project was successful in improving the families’ interactions and understanding of their role in the patient’s discharge. It may be beneficial to remove the whole burden from the nursing staff and have one common supervising provider or discharge coordinator to aid in education of parents and providing clinical information.
Implications for practice. Patients and their families would benefit from a coordinator of their discharge planning and education to enable patients to go home on time with confident and competent families.