Welcome to 2016! I hope each of you had wonderful holiday and are headed into the new year with more plans and goals, especially for Baby-Friendly changes. This week, I read a terrific article on putting the mother-baby model of nursing care into practice at one US facility. This article is full of extremely helpful information, diagrams, quality improvement tools, use of the Iowa model of evidence-based practice to promote quality care, and the outcomes of instituting such a change. I will provide you with the DOI, and you might want to check with your hospital or clinic to see if they have access to Nursing for Women's Health, a publication of AWHONN.
Author Vicki Brockman opens the article with, "Research has shown improved maternal and newborn health outcomes when women and newborns stay together from the moment of birth. Therefore, nursing practices have changed to support a family-centered environment. This article describes how our facility utilized change theory, models of evidence-based practice and quality improvement tools to transition from the traditional model of obstetric nursing to mother-baby couplet care, resulting in a positive family experience and improved clinical and financial outcomes, " (2015).
This facility averages 2400 births annually, with 20% of newborns admitted to the NICU, and had a separate newborn nursery as well as separate labor and postpartum units. Uninterrupted skin-to-skin care (SSC) did not occur immediately post-delivery, and rooming-in was optional. The decision was made to change this costly care model (financially, emotionally, staffing, and health related) to evidence-based and best practice couplet care with immediate and prolonged SSC, continuing throughout the mother's stay. Although this hospital was not seeking the BFHI designation, the change involved the same changes we see facilities undergo to meet the BFHI criteria for designation.
Change was started using the Iowa Model of Evidence-Based Practice to Improve Quality Care because it was developed (2001) to support the work of "interdisciplinary teams in researching, implementing and evaluating evidence-based practice." A full-page flow diagram is shown which details the triggers, priorities, team work, research, data collection, and dissemination of results. As well, details are provided on workflow, staff education, model application, and failure modes.
One of the more interesting outcomes from Brockman's project was the financial savings experienced by the facility, with a salary per patient day decreasing by 16%. Leaders also found extra space with the closing of the nursery, leading to conference and education areas. Brockman stated, "the primary costs of this project were staff salaries due to the extensive education required. Although it might be tempting to skimp on education, this would jeopardize success; it's essential that staff have the necessary time to attend both didactic offerings and unit bedside cross-training opportunities." Staff survey results revealed better bonding for mother and baby, fewer staff communication errors, better breastfeeding success, and a unity among the staff.
If you are trying to facilitate major changes in your own facility, I would encourage getting a copy of this article to assist in moving that change forward.
Brockman, V. (2015). Implementing the mother-baby model of nursing care using models and quality improvement tools. Nursing for Women's Health; 19(6): 490. DOI: 10.1111/1751-486X.12245
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