NICQ 2018-19 Homerooms

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NICQ 2018-19 Homerooms

We are currently identifying topics of interest. Please fill out the questionnaire at this link to express interest or request more information. Potential topics are detailed below.

Optimizing Outcomes of the Micro-Premature Infant

Focus on infants at the highest risk for morbidity and mortality which are micro-premature infants (typically less than 26 completed weeks gestational age)

  • Improvement areas include:
    • Delivery room practices
    • The golden hour (first hour of life)
    • Critical first 72 hours including fluid management, skin care, nutrition, respiratory support, and neurological care
  • Small baby care team / unit
  • 2 person cares
  • Developmentally appropriate care
Minimizing Lung Injury

Focus on the NICU population <30wks  and/or ≤1500 grams who at the highest risk for chronic lung disease (CLD) or death.

  • Use of antenatal steroids
  • Minimally invasive respiratory support
  • Appropriate use of surfactant
  • Optimal ventilatory weaning practices
Minimizing Brain Injury

Focus on minimizing the incidence of intraventricular hemorrhage (IVH)

  • Brain monitoring and neuro-imaging
  • Effectively manage seizure
  • Therapeutic hypothermia, and hypoxic-ischemic encephalopathy (HIE)
  • Neourologic follow up
Optimizing Nutrition

This group will develop evidence-based nutritional support guidelines for extremely premature infants.

  • Optimize nutritional management to reduce extrauterine growth restriction (EUGR) through the use of early, intense parenteral and enteral nutrition
    • Donor human milk to supplement mother’s own milk
    • Intense parenteral and enteral nutrition strategies
    • Support lactation through to discharge and beyond
Minimizing Necrotizing Enterocolitis (NEC)

Establish nutritional support and other strategies that reduce the risk of gastrointestinal atrophy and improve the use of mother’s own milk.

  • Limit use of medications that may contribute to the development of NEC
  • Donor human milk to supplement mother’s own milk
  • Support lactation through to discharge
Improving Outcomes for Infants Requiring Surgery

Improve common surgical care processes, with a focus on critical handoffs throughout the hospital stay

  • Interdisciplinary cross-specialty teams with defined roles and responsibilities
  • Standardize care to decrease random variability
  • Staff to achieve consistent, effective, high-quality care
  • Integrate parents and families fully as members of the care team and quality team
  • Use audits, feedback, and review of care deviations to promote best practice
Improving Teams and Teamwork

Use scientific strategies to increase capacity for teamwork.

  • Core Processes and Emergent States for improvement in the domains of:
    • Cooperation – teammate engagement in collective activities, actions, and behaviors
    • Coordination – practice performance monitoring capabilities and promote backup behavior
    • Cognition – clear roles and responsibilities and shared mental model
    • Conflict – develop norms for healthy conflict and standard means to resolve in a healthy and timely way
    • Coaching – ensure access to team leader providing dedicated coaching and support for team development
    • Communication – protocols that ensure accurate, timely, and precise information among and between team members and with parents

Family Engagement and Senior Leadership are influencing conditions for successful improvement in all domains.

Telemedicine

Improving care and outcomes by improving communication and collaboration support by technology.

  • Opportunities and processes:
    • Pre-transport
    • Consultation during nursery stay
    • Post-Discharge and Follow Up
  • Strategies to address reimbursement, licensing, credentialing, technology
Follow Up and Follow Through

Establishing a continuum of care that meets the needs of infants, children, and families, achieving optimal functionality for the child, and minimizing stress for the parents.

  • Collaboration with community resources and providers
  • Support of family to advocate effectively for infant and themselves
  • Developmental touch points – goal-based visits focused on child/family
  • Supporting parental health – physical, emotional
  • Early intervention – indication, identification, timing, intensity
  • Data collection – purpose, strategy, use
Achieving Safe Practices

Establish highly reliable processes and practices to minimize errors and optimize patient safety in the NICU.

  • Understand and identify risks – failure mode and effects analyses
  • Use of simulation to test new processes, refine, standardize, and reinforce
  • Debrief to identify opportunities to improve reliability
  • Integrate practices and tools into standard workflow
  • Utilize effective teamwork
Neonatal Abstinence Syndrome (NAS)

Provide comprehensive care and support to optimize experience for infants with NAS and for the mother and family.

  • Identification of infant with NAS
  • Evaluation of infant with NAS
  • Treatment of infant with NAS
  • Create a culture of compassion, understanding, and healing for the mother-infant dyad
  • Discharge management of infant with NAS
  • Measuring and reporting rates of NAS and drug exposure
Neonatal Intensive Parenting Unit

Establish culture and practices that nurture and optimally support parents and families.

  • Determine status of NICU family-centeredness with self-assessment
  • Align hierarchy of Potentially Better Practices with opportunities identified
  • Engage practices and partnerships that support parental wellbeing
  • Support families to fulfill their parenting roles as defined by them
  • As tiers of improvement are achieved, reassess NICU status and align with incremental hierarchy of Potentially Better Practices
Neonatal Transport
  • Training effectiveness through use of simulation and other methods/tools
  • Team composition, collaboration
  • Teamwork and team training
  • Transport system and related processes
  • Equipment, supplies, processes, and documentation