Breaking Down the Silos: Promoting Quality Neonatal Outcomes within the Women's and Children's Service Line

Purpose for the program: In the past, a NICU charge nurse and NICU respiratory therapist attended cesarean sections and transported the infant to the transition nursery on the Mother-Baby Unit (MBU). This process was not complimentary to the family centered environment we promote.  A specially trained mother-baby nurse now attends uncompromised cesarean sections. This partnership resulted in decreased NICU admissions, decreased anxiety and increased bonding with the family and newborn, as well as improved productivity and an enhanced professional relationship between the departments.

Proposed change: In an effort to provide more family centered care, responsibilities were reallocated, allowing the NICU nurse to remain available for neonatal emergencies while the MBU nurse manages the initial stabilization of the neonate in the cesarean delivery.

 Implementation, outcomes and evaluation: The management team and staff from NICU and MBU collaborated to identify current gaps in process, specific recurrent issues, and opportunities for improvement. First, the management evaluated staffing feasibility and identified that one staff nurse could be allocated to attend the cesarean section. Second, a competency plan was set in place. The NICU charge nurse trained the first two MBU nurses in the OR. After completing their competency, they became super users and initiated the training for MBU nurses. MBU nurses were chosen to complete this training based on their passion to broaden their skill set to include the immediate management of the infant during a cesarean delivery and remain on the cutting edge of the latest techniques. Finally, the MBU nurse completed one on one competencies with the super users, completing the training requirements. Guidelines were set to ensure only nurses who had completed the competency managed the infant during a cesarean section. It was identified in the training phase that code buttons were absent in the L&D OR’s, which would notify NICU staff when there was an emergency situation.  These were then installed before moving forward with the process.

Implications for nursing practice:  Six months after implementing this process 47 % of cesarean deliveries have been attended by MBU nurses. This process has proven to increase continuity of care and patient satisfaction.  It has also driven down the cost associated with well baby care. MBU nurses gained knowledge and confidence in caring for the mildly compromised infant, thus decreasing unnecessary NICU admissions. This has resulted in less parent/family anxiety, as the infant remains on the same unit.

Keywords: Cesarean Deliveries/ Bonding/ Competency