NICQ: Newborn Improvement Collaborative for Quality

Homeroom Structure and Project Examples

Homerooms of up to 10 teams focus their improvement in similar ways. Homerooms can be organized by:

  • a distinct phase or collection of phases of care
  • a single key driver such as Communication/Teamwork, Families as Partners, or Health Equity across all phases, or
  • a specific clinical topic or outcome measure across all phases of care and key drivers for transitions.

Potential improvement topics by phase are listed below.

Potential Areas for Improvement

Pre-admission Outborn

  • Transport handoff tools; checklists
  • Integration of families into handoff process
  • Simulation
  • Communication w birthing NICU
  • Preparation of family including remote communication
  • Initiate family Peer Support
  • Telemedicine
  • Screen family for social risk & support

Pre-admission Inborn

  • Handoff with maternal-fetal medicine
  • Briefs, huddles, debrief w Antenatal and Birthing teams
  • Processes (teamwork informing clinical care) for optimal transition to extrauterine life
  • Integrate family w informed consent; coach; documents
  • Screen family for social risk & support
  • Initiate family Peer Support

Golden Hours

  • Briefs, huddles, debriefs
  • Develop verbal, written & graphic modes of communication
  • Develop checklists, decision tools, pathways to optimize clinical outcomes (minimally invasive vent’n; dev care)
  • Simulation to strengthen teamwork
  • Family peer support

Acute

  • Integrate family members into bedside teams
  • briefs, huddles, and debriefs into transition points incl. pre-post surgical
  • Develop family-led rounds
  • Begin discharge planning and teaching at admission
  • Facilitate parent support groups & peer counselling
  • Optimize all physiologic systems

Growing Stronger

  • Optimize nutritional transitions
  • Maximize skin-to-skin (site of care)
  • Provide parenting & family support tailored to individual family strengths
  • checklists for transition points
  • Include family in developing and evaluating daily care plans
  • Collaboration to stabilize systems

Breathing/Feeding/Growing

  • Support family’s shared decision-making
  • Provide mental health services for families
  • Checklists and clinical pathways supporting family & staff expectations
  • Educate and support families as the primary caregivers
  • Build decision aids and reminders into the system

Transition Home or Transfer

  • Handoff tools
  • Checklists
  • Multi-modal communication for family
  • Provide post-discharge anticipatory guidance
  • Facilitate parent support groups & peer counselling that extend beyond the stay
  • Facilitate transition to peds, family practitioner, referrals to all relevant services

Follow-up and Follow-Through

  • Provide high risk infant follow up
  • Provide telehealth support after discharge
  • Provide mental health and addiction services for families after the stay
  • Utilize innovative approaches to medical visits
  • Handoff tools supporting communication with specialists and services

Palliative Care and Bereavement

  • Integrate family members into bedside teams; clear roles for team
  • Develop individualized shared communication plans with families
  • Educate and support families as partners in the care of their infant
  • Include family in developing and evaluating daily care plans
  • Standardize the expectation and mechanism to screen and address each family’s emotional and spiritual health/needs
  • Make the environment welcoming and comfortable for families
  • Provide peer-to-peer support
  • Provide communication and support that is cultural sensitivity
  • Pain identification & management
  • Interdisciplinary Palliative Care teams
  • Home based hospice care
  • Grief support for families including siblings
  • Collaboration with Bioethics
Toolkit Excerpt

Evidence-Based Toolkits Support Improvement

Toolkits with change ideas and potentially better practices rooted in evidence are available to teams for every phase of care.

Faculty skilled in the clinical application of evidence through disciplined QI methods guide teams as they implement changes to policies and practices.

VON uses the term “potentially better practices” to indicate that no practice is better or best until adapted, tested, and shown to work in the local context. Measurement and reporting available through VON help teams understand how the changes are affecting care at their center.