Neonatal couplet care

Nicole Pendenza, RNC-NIC,BSN Tanya DiGeorge, RN, BSN

Catholic Medical Center Manchester, NH

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Hello and thank you for having us. I am Nicole Pendenza Director of the SCN and FCS and this is Tanya DiGeorge, Clinical Nurse Manager of the SCN And FCS at CMC Opened SCN 2 ½ years ago I know it has been a great morning and hope you can bear with us until lunch where you can enjoy this amazing CA weather I hope you find this a exciting as we think it is and I hope after this presentation you may have a new passion for keeping mom’s and babies together

Catholic Medical Center is a 330 bed community hospital in Manchester, NH

In affiliation with Children’s Hospital at Dartmouth, Catholic Medical Center

opened the Special Care Nursery in April 2010

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Before we go into detail on what neonatal couplet care is, Background on CMC When I say community hospital, please remember it is in one of the biggest cities in NH We have very similar problems big urban hospitals have, some would argue even more. Many of our nurses including myself worked in large hospitals in Boston, and would argue that we care for a similar patient population at CMC

The Mom’s Place at CMC

•1200 Deliveries per year

•14 bed LDRP, including 2 operating rooms

•Maternal Fetal Medicine Service

•12 bed Level IIB Special Care Nursery

•2 Methadone clinics within the city

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Just alittle bit about our delivery service

Our mission is to provide individualized, high quality, tender care to each infant and their family. This is achieved by providing an optimal environment for mother/baby attachment using the neonatal couplet care model. This model of care assists parents in becoming primary caretakers for their infants with the support of our healthcare team.

Mission Statement

Neonatal Couplet Care is the next step in Family Centered Care

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This picture is an example of what Neonatal Couplet care means to us. Infant immediately skin to skin after c-section, but before we explain where we are now, we should review where we have been, and where some of you may still be.

Open Bay Neonatal Intensive Care Unit

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Open Bay Little privacy for families Nurse centered not family centered, much like the NICU that I came from, one big room with babies lined up and nurses in the middle. Even down to the table in the middle of the room for the nurses, reinforcing that is really about the nurses not about the families.

“Pod” Style NICU’s

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Beautiful, trying to be more family center, but still about keeping it nursing at the center. still not a lot of privacy for the patients.

Single Family Rooms

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Now, wala the single family room, family centered, encouraging families to stay with there baby, welcoming, warm, feels like home, BUT what is missing? What do you do when you are still a postpartum patient? When can you “visit” your baby? How much time were you able to spend with your baby? How many of us have been to a delivery of a 32 weeker, baby comes out looking good, maybe needing CPAP OR just needing an IV, labs, antibiotics, and you show the mom her baby, maybe even let her hold him/her for a couple of minutes…… then the baby is “wisked” away to the NICU where we as nurses do what we do best, get all our tasked finished. Then 1-2 hours later and some would argue more, mom is brought by for a “visit” before she goes to the postpartum floor for another extended period of time before she is able to visit again. Then you had the dad’s that are agonizing and torn between being with their new baby or their wife/girlfriend. That is what makes us different at cmc.

Neonatal Couplet Care at Catholic Medical Center (CMC) Family Care Suites

Postpartum Bed and NICU Bed in the same room

Neonatal Couplet Care at CMC Family Care Suite

Special Care Nursery at CMC

Patient Population in the Special Care Nursery 32 weeks or greater Short term ventilation (< 24 hours) CPAP, High Flow Nasal Cannula, Oxygen Hood Infants requiring “special care” (i.e. NAS, long term

antibiotics, etc.) Retro transfers from tertiary care facilities

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When I say Level IIB nursery, this is what I mean, I know it can differ in from state to state, depending on the regulatory governing bodies, but we adopted what the AAP statement that a level 11B nursery is… Tube and surf

What is Neonatal Couplet Care?

Care provided to a postpartum mother in the same room as Neonatal Intensive Care is provided to the infant.

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So now that you know about us at CMC, I want to explain about neonatal couplet care. This model of care was adopted from the Swedish model of Neonatal couplet care when they have been doing this for many years and have had great success. Even reporting in Pediatric in 2011 that they have a lower LOS and mortality that traditional model NICU’s As you can see in the picture this is a mom of 33 wk twin 2 hours post op skin to skin with baby on cpap and dad holding other next

What is Neonatal Couplet Care?

Families stay together from admission to discharge Minimized separation Early skin-to-skin contact Early parental involvement Parents feel confident to become primary caregivers-

comfortable at discharge Parent’s presence enables more prompt

responses/tuning in on the signals of the infant

How does it “really” work?? 1. Infant born on The Mom’s Place (LDRP)

2. Stabilized in delivery room

3. Infant placed on mom or dad’s chest and transferred to the

Special Care Nursery into a Family Care Suite (FCS)

4. SCN nurse assumes care for the Couplet (post partum care

and neonatal care)

5. Couplet remains in FCS until mom is discharged

6. Infant transferred to SCN room until ready to go home

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So this room full of NICU nurses is asking, sure how does this really work…. So Im sure your all thinking how does a NICU nurse care for a postpartum patient?

32 week infant stabilized in delivery room and skin-to-skin within ½ hour

33 week twins born by c-section and placed skin-to-skin in the OR

Transferred to FCS for recovery/care

Labs drawn and PIV started on 33 weeker while breastfeeding

•Parents are encouraged to stay with

their babies 24/7 (when possible)

•Our philosophy is to have nurses act

as “coaches” to parents

•Parents feel confident to become

primary caregivers so they are

comfortable at discharge

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Talk more about philosophy once mom is dc’d

Benefits of Neonatal Couplet Care •Increases exclusive breastfeeding

•Increased amounts and durations of kangaroo care

•Parents are more prepared at discharge

•High job satisfaction ratings (NDNQI survey)

•Decreased staff turn over

•Decreased Length of Stay for NAS babies

Neonatal couplet care

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Transcript of Neonatal couplet care