KANGAROO CARE IN THE NEONATAL INTENSIVE CARE UNIT: A ... · QI project: In the neonatal intensive...
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KANGAROO CARE IN THE NEONATAL INTENSIVE CARE UNIT: A QUALTY IMPROVEMENT PROJECT Courtney Kuklinski, BSN, RN, DNP Student University of Missouri-Sinclair School of Nursing § Prematurity: number one cause of newborn deaths and the second leading cause of death in children under age five (Althabe et al., 2012). § Currently in the United States one in eight infants is born premature (Althabe et al., 2012). § The World Health Organization (WHO) set a goal for 2025 to “eliminate remaining preventable preterm deaths, focusing on equitable care for all and quality of care to minimize long-term impairment” (Althabe et al., 2012, p. 7). § Kangaroo care (KC) has become the standard of care for all preterm infants (Engmann, Wall, Darmstadt, Valsangkar, & Claeson, 2013). § The WHO conducted a saving lives analysis and determined KC could avert 48% of neonatal deaths (Althabe et al., 2012). § Educational interventions increase utilization of kangaroo care (Hendricks-Munoz & Mayers, 2014; Stikes & Barbier, 2013). INTRODUCTION Design: • Descriptive, longitudinal, quality improvement design. Interventions: • Parent brochures given on admission • Nurse training program provided through the computerized education website, HealthStream. Data Collection: • Using a confidence interval of 95%, a maximum of 7.5% margin of error, a population size of 172, with a 50% response distribution, a minimum of 120 charts were required at baseline and follow-up (Raosoft, Inc., n.d.). • All available charts were utilized at baseline (n = 79) and one- month follow-up (n = 15). Measures: • Descriptive statistics were utilized to provide an overview of the project sample. • Nominal level data was analyzed with the Chi-square of Independence and the phi coefficient (ϕ) was used as an index to describe the magnitude of the effect from the intervention. • Ratio level data was analyzed with the Independent t-test and the Cohen’s d coefficient was used as an index to describe the magnitude of the effect. • The level of significance was set at p ≤ .05. Gestational Age (GA) § Median GA for the baseline group was 34.4 weeks, and 36.6 for the follow-up group which was statistically significant, t(92) = -2.67, p = .01, 95% CI [-4.42, -.645]. Birth Weight (BW) § Mean BW of the baseline group was 2238 grams (g) (SD = 812) and a 2551g (SD = 600) for the follow-up group which was not statistically significant t(92) = -1.42, p = .16. MATERIALS AND METHODS Althabe, F., Howson, C. P., Kinney, M., Lawn, J., & World Health Organization. (2012). Born too soon: the global action report on preterm birth. Retrieved from http://www.who.int/pmnch/media/news/ 2012/201204_borntoosoon-report.pdf Engmann, C., Wall, S., Darmstadt, G., Valsangkar, B., & Claeson, M. (2013). Consensus on kangaroo mother care acceleration. The Lancet, 382(9907), e26–e27. doi: 10.1016/S0140-6736(13)62293-X Hendricks-Munoz, K., & Mayers, R. (2014). A neonatal nurse training program in kangaroo mother care (KMC) decreases barriers to KMC utilization in the nicu. American Journal of Perinatology, 31(11), 987–992. doi:10.1055/s-0034-1371359 Raosoft, Inc. (n.d.). Sample Size Calculator. Retrieved June 24, 2016, from http://www.raosoft.com/ samplesize.html Stikes, R., & Barbier, D. (2013). Applying the plan-do-study-act model to increase the use of kangaroo care. Journal of Nursing Management, 21(1), 70–78. http://doi.org/10.1111/jonm.12021 • Objective one: 75% of infants participating in KC in the first 48 hours was not met. Although an increase from 30% to 60% was seen. • Objective two: 95% of infants participating in KC in the first week of life was not met. An increase from 54% to 67% was achieved. The implementation of evidence-based parent and nursing education contributed to a clinical improvement in the participation in kangaroo care. The weight at discharge and length of stay were significantly lower in the follow up groups, potentially leading to substantial cost savings. Contact: [email protected], http://nursing.missouri.edu/index.php Kangaroo Care in the first 48hours § KC increased from 30% at baseline to 60% at follow-up, χ 2 (1) = 4.86, p = .03, Φ = .2. § Infants in the follow-up group were almost three times more likely to participate in kangaroo care within the first 48 hours, OR = 2.77, 95% CI [1.08, 7.11]. Kangaroo Care in the first week § KC increased from 54% at baseline to 67% in the follow-up group, χ 2 (1) = .768, p = .38, Φ = .1 Weight at Discharge § The baseline group was 3019g (SD = 666) compared to 2649g (SD = 468) in the follow-up group, t(92) = 2.05, p = .04, 95% CI [11.6, 728.2], d = .4 Length of Stay § There was a dramatic decrease from the baseline group (M = 34.7, SD = 25.9) to the follow-up group (M = 15.6, SD = 8.89) that was both statistically and clinically significant, t(65) = 5.16, p = .00, 95% CI [11.7, 26.5], d = 1. § A potential cost-savings of $230,806.69 could result due to the decrease length of stay. RESULTS CONCLUSIONS REFERENCES RESULTS ACKNOWLEDGEMENTS The project director would like to thank her doctoral committee chair: Dr. Jan Sherman, PhD, RN, NNP-BC; members: Dr. Urmeka Jefferson, PhD, RNC-LRN; Karen Kopischke, MS, APRN, NNP-BC; and the Overland Park Regional Medical Center NICU for their support and direction with this project. PICOT AND PROJECT OBJECTIVES PICOT: § The following PICOT question will guide this QI project: In the neonatal intensive care unit (P) how does Kangaroo Care education (I) affect time to first hold (O) within a one-month timeframe (T). Objectives: 1) 75% of infants will participate in kangaroo care in the first 48 hours of life. 2) 95% of infants will participate in kangaroo care within the first week of life. 0 5 10 15 20 25 30 35 Length of Stay Baseline Follow-up 0% 10% 20% 30% 40% 50% 60% 70% KC in first 48hr KC in first week Baseline Follow-up 2400 2500 2600 2700 2800 2900 3000 3100 Weight at Discharge (g) Baseline Follow-up
Transcript of KANGAROO CARE IN THE NEONATAL INTENSIVE CARE UNIT: A ... · QI project: In the neonatal intensive...
KANGAROO CARE IN THE NEONATAL INTENSIVE CARE UNIT: A QUALTY IMPROVEMENT PROJECT
Courtney Kuklinski, BSN, RN, DNP Student University of Missouri-Sinclair School of Nursing
§ Prematurity: number one cause of newborn deaths and the second leading cause of death in children under age five (Althabe et al., 2012).
§ Currently in the United States one in eight infants is born premature (Althabe et al., 2012).
§ The World Health Organization (WHO) set a goal for 2025 to “eliminate remaining preventable preterm deaths, focusing on equitable care for all and quality of care to minimize long-term impairment” (Althabe et al., 2012, p. 7).
§ Kangaroo care (KC) has become the standard of care for all preterm infants (Engmann, Wall, Darmstadt, Valsangkar, & Claeson, 2013).
§ The WHO conducted a saving lives analysis and determined KC could avert 48% of neonatal deaths (Althabe et al., 2012).
§ Educational interventions increase utilization of kangaroo care (Hendricks-Munoz & Mayers, 2014; Stikes & Barbier, 2013).
INTRODUCTION
Design: • Descriptive, longitudinal, quality improvement design.
Interventions:
• Parent brochures given on admission • Nurse training program provided through the computerized
education website, HealthStream.
Data Collection:
• Using a confidence interval of 95%, a maximum of 7.5% margin of error, a population size of 172, with a 50% response distribution, a minimum of 120 charts were required at baseline and follow-up (Raosoft, Inc., n.d.).
• All available charts were utilized at baseline (n = 79) and one-month follow-up (n = 15).
Measures:
• Descriptive statistics were utilized to provide an overview of the project sample.
• Nominal level data was analyzed with the Chi-square of Independence and the phi coefficient (ϕ) was used as an index to describe the magnitude of the effect from the intervention.
• Ratio level data was analyzed with the Independent t-test and the Cohen’s d coefficient was used as an index to describe the magnitude of the effect.
• The level of significance was set at p ≤ .05.
Gestational Age (GA) § Median GA for the baseline group was 34.4 weeks, and 36.6 for
the follow-up group which was statistically significant, t(92) = -2.67, p = .01, 95% CI [-4.42, -.645].
Birth Weight (BW) § Mean BW of the baseline group was 2238 grams (g) (SD = 812)
and a 2551g (SD = 600) for the follow-up group which was not statistically significant t(92) = -1.42, p = .16.
MATERIALS AND METHODS
Althabe, F., Howson, C. P., Kinney, M., Lawn, J., & World Health Organization. (2012). Born too soon: the global action report on preterm birth. Retrieved from http://www.who.int/pmnch/media/news/2012/201204_borntoosoon-report.pdf
Engmann, C., Wall, S., Darmstadt, G., Valsangkar, B., & Claeson, M. (2013). Consensus on kangaroo mother care acceleration. The Lancet, 382(9907), e26–e27. doi: 10.1016/S0140-6736(13)62293-X
Hendricks-Munoz, K., & Mayers, R. (2014). A neonatal nurse training program in kangaroo mother care (KMC) decreases barriers to KMC utilization in the nicu. American Journal of Perinatology, 31(11), 987–992. doi:10.1055/s-0034-1371359
Raosoft, Inc. (n.d.). Sample Size Calculator. Retrieved June 24, 2016, from http://www.raosoft.com/samplesize.html
Stikes, R., & Barbier, D. (2013). Applying the plan-do-study-act model to increase the use of kangaroo care. Journal of Nursing Management, 21(1), 70–78. http://doi.org/10.1111/jonm.12021
• Objective one: 75% of infants participating in KC in the first 48 hours was not met. Although an increase from 30% to 60% was seen.
• Objective two: 95% of infants participating in KC in the first week of life was not met. An increase from 54% to 67% was achieved.
The implementation of evidence-based parent and nursing education contributed to a clinical improvement in the participation in kangaroo care. The weight at discharge and length of stay were significantly lower in the follow up groups, potentially leading to substantial cost savings.
Contact: [email protected], http://nursing.missouri.edu/index.php
Kangaroo Care in the first 48hours § KC increased from 30% at baseline to 60% at follow-up, χ2 (1)
= 4.86, p = .03, Φ = .2. § Infants in the follow-up group were almost three times more
likely to participate in kangaroo care within the first 48 hours, OR = 2.77, 95% CI [1.08, 7.11].
Kangaroo Care in the first week § KC increased from 54% at baseline to 67% in the follow-up
group, χ2 (1) = .768, p = .38, Φ = .1 Weight at Discharge § The baseline group was 3019g (SD = 666) compared to 2649g
(SD = 468) in the follow-up group, t(92) = 2.05, p = .04, 95% CI [11.6, 728.2], d = .4
Length of Stay § There was a dramatic decrease from the baseline group (M =
34.7, SD = 25.9) to the follow-up group (M = 15.6, SD = 8.89) that was both statistically and clinically significant, t(65) = 5.16, p = .00, 95% CI [11.7, 26.5], d = 1.
§ A potential cost-savings of $230,806.69 could result due to the decrease length of stay.
RESULTS
CONCLUSIONS
REFERENCES
RESULTS
ACKNOWLEDGEMENTS The project director would like to thank her doctoral committee chair: Dr. Jan Sherman, PhD, RN, NNP-BC; members: Dr. Urmeka Jefferson, PhD, RNC-LRN; Karen Kopischke, MS, APRN, NNP-BC; and the Overland Park Regional Medical Center NICU for their support and direction with this project.
PICOT AND PROJECT OBJECTIVES
PICOT: § The following PICOT question will guide this
QI project: In the neonatal intensive care unit (P) how does Kangaroo Care education (I) affect time to first hold (O) within a one-month timeframe (T).
Objectives: 1) 75% of infants will participate in kangaroo care
in the first 48 hours of life. 2) 95% of infants will participate in kangaroo care
within the first week of life.
0
5
10
15
20
25
30
35
Length of Stay
Baseline Follow-up
0%
10%
20%
30%
40%
50%
60%
70%
KC in first 48hr KC in first week
Baseline Follow-up
2400
2500
2600
2700
2800
2900
3000
3100
Weight at Discharge (g)
Baseline Follow-up
