Objective: 100% medically stable mothers and infants to spend greater than 30 minutes skin-to-skin within the first hour of birth.

Design: Quality improvement implementation project.

Patients/Participants: Mother/infant dyads immediately after birth, and labor and delivery RNs and respiratory therapists present in the first hour after delivery

Methods: The quality improvement method used at this hospital was MAP-IT.

Implementation Strategies:

Mobilize:  An interdisciplinary project leadership team was formed and sustained. The team included the birth center nurse manager, educator, Neonatal Resuscitation team respiratory therapist,  a lactation consultant and a RN project leader.

Assess: Skin-to-skin frequency and RN practices and knowledge were assessed pre-, during, and post-implementation.  Frequency of timed skin-to-skin contact was recorded in patients’ electronic health records.

Plan: The team developed a plan with short and long-term objectives summarized using a logic model.

Implementation: Nursing and respiratory staff members were educated about benefits of mother/ infant skin-to-skin contact, strategies to implement the practice, and the process for accurate documentation.

Track: Monthly data were evaluated and project adjustments made. Graphs provided visual information to staff and leadership about the steady improvement in accurate documentation and rates of skin-to- skin contact.

Results: Accurate skin-to-skin documentation increased from 40% to 90% over a 6-month period.  Skin-to-skin contact for 30 minutes or more increased from 58% to 83%. 

Conclusion/Implications for nursing practice: A multidisciplinary team with a comprehensive plan and sustained focus led to more frequent skin-to-skin contact.

Keywords: skin-to-skin, bonding, breastfeeding, quality improvement, implementation