A12 Core Measures for Age-Appropriate Care in the NICU Mary Coughlin, MS, NNP President and Global Learning Officer Caring Essentials Collaborative, LLC, Boston, MA The speaker has signed a disclosure form and indicated she has no significant financial interest or relationship with the companies or the manufacturer(s) of any commercial product and/or service that will be discussed as part of this presentation. Session Summary The five primary drivers of an exceptional inpatient experience for patients/families include commitment of leadership, engagement of the hearts and minds of staff, respectful partnerships, reliable care, and evidence-based care. These drivers are embodied in the five core measures for age-appropriate care (developmental care): protected sleep, pain and stress assessment and management, attention to ageappropriate activities of daily living, family-centered care, and the healing environment. Linking ageappropriate care practices with the Joint Commission s standards that all clinicians meet the ageappropriate needs of the patient population served legitimizes and mandates this practice model and provides a framework for the consistent and reliable delivery of age-appropriate care. Session Objectives Upon completion of this presentation, the participant will be able to: describe Erikson s first stage of psycho-social development; list the five core measures for age-appropriate care; identify one evidence-based outcome associated with the application of the core measures in clinical practice. References Carter, M.A. (2009). Trust, power, and vulnerability: A discourse on helping in nursing. Nursing Clinics of North America, 44: 393-405. Coughlin, M. (2014). Transformative nursing in the NICU: Trauma-informed age-appropriate care. New York, NY: Springer Publishing. Coughlin, M. (2011). Age-appropriate care of the premature and critically ill hospitalized infant: Guideline for practice. Glenview, IL: National Association of Neonatal Nurses. Coughlin, M., Gibbins, S. & Hoath, S. (2009). Core measures for developmentally supportive care: Theory, precedence, and practice. Journal of Advanced Nursing, 65(10): 2239-2248. Gibbins, S., Coughlin, M. & Hoath, S. (2010). Quality indicators for developmental care: Using the universe of developmental care model as an exemplar for change. In C. Kenner & J. McGrath (Eds.) Developmental care of A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 1 of 8
newborns and infants: A guide for health professionals (2 nd ed., pp. 43-59). Glenview, IL: National Association of Neonatal Nurses. Gibbins, S., Hoath, S.B., Coughlin, M.E., Gibbins, A. & and Franck, L. (2008). The universe of developmental care: A new conceptual model for application in the neonatal intensive care unit. Advances in Neonatal Care, 8(3): 141-147. Gorovitz, S. (1994). Is caring a viable component of health care? Health Care Analysis, 2: 129-133. Liaw, J-L., Yang, L., Chou, H-L., et al. (2010). Relationships between nurse care-giving behaviours and preterm infant responses during bathing: A preliminary study. Journal of Clinical Nursing, 19: 89-99. Maton, P. & Francoise, A. (2011, June 18). Global care program. Oral presentation at the XXVII rencontre de néonatologie (Rocourt): The neonatal environment, Rocourt, Belgium. Montirosso, R., Del Prete, A., Bellu, R., Tronick, E., Borgatti, R., et al. (2012). Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics, 129(5): e1129-e1137. Nightingale, F. (1969). Notes on Nursing. Mineola, NY: Dover Publications, Inc. Session Outline See presentation handout on the following pages. A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 2 of 8
Disclosure Core Measures for Age-Appropriate Care in the NICU Mary Coughlin is President and Founder of Caring Essentials Collaborative, LLC, has nothing to disclose Mary Coughlin RN, MS, NNP President and Global Learning Officer Caring Essentials Collaborative Boston, MA Objectives Age Appropriate Upon completion the participant will be able to: 1. Describe Erikson s first stage of psycho-social development 2. List the 5 core measures for age appropriate care 3. Identify 1 evidence based outcome associated with the application of the core measures in clinical practice. 3 Erikson Life-Stage Virtues HOPE basic trust vs. mistrust (0-1) WILL autonomy vs. shame & doubt (1-3) PURPOSE initiative vs. guilt (3-6) COMPETENCE industry vs. inferiority y( (6-11) FIDELITY identity vs. role confusion (12-mid 20 s) LOVE intimacy vs. isolation (young adult mid 20 s to early 40 s) CARING generativity vs. stagnation (40 s to 60 s) WISDOM ego integrity vs. despair (>60 s) A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 3 of 8
Nightingale Legacy The nurse is responsible for creating and maintaining an environment conducive to the healing gprocess. Compassion Commitment to patient safety Diligent & thoughtful hospital administration Teamwork Nightingale 1860 Clinical Audit Pioneer A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 4 of 8
Experience of Care Quality of Developmental Care Impacts Neurobehavioral Performance Protected Sleep Assess Protect Support Healing Environment Physical sensory, space, aesthetics Human communication, caring, collaboration System standards, accountability, resources CORE MEASURES for AGE APPROPRIATE CARE Pain & Stress Assessment and Management Assess Manage Mitigate Family Centered Care Define Assess Empower & Educate Activities of Daily Living Posture/mobility Alimentation Hygiene Montirosso et al 2012 Coughlin et al 2009; Coughlin 2011; Coughlin 2014 Human Prevention Physical Systems Healing Environment Management Pain & Stress Assessment A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 5 of 8
Support Protect Alimentation Educate Posture / Mobility Hygiene / Skin Care Sleep Activities of Daily Living Assess Access Family Central Care Partnership Clinical Outcomes Maton & Francoise 2011 Clinical outcomes Observational cohort : all <32W admissions Comparaison of 3 periods BEFORE 1/2006 til 6/2007 AFTER 1. 11/2007 til 4/2009 + f/up @ 2yrs AFTER 2. 5/2009 til 10/2010 Based on NICAUDIT criteria Belgian neonatal network registry Major clinical outcomes Population Before Period 1 Period 2 total 106 130 117 Male sex (%) 54 (50,9) 81(62,3) 69 (58,9) <26 4 11 17 26-<28 23 22 18 28-<32 79 97 82 Mean GA (SD) 28,9 (1,9) 28,7 (1,9) 28,9 (2,2) Mean BW (SD) 1226 (333) 1331 (377) 1250 (355) Mean 5 Apgar 7,9 7,9 8,1 A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 6 of 8
Neurological outcomes (%) Other outcomes (%) 2yrs Followup data Neurodevelopmental disability (%) as per BAPM Before (106) After (130) Discharged 91 120 Post NN death 1 0 Followed up @ 2yrs 65 (71%) 102 (85%) Neurodevelopmental outcomes II (%) Other outcomes (%) A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 7 of 8
http://www.youtube.com/watch?v=cddwvj_q-o8 A Person is a Person mec@caringessentials.org http://www.youtube.com/watch?v=hlrvr_mp8t8 A12: CORE MEASURES FOR AGE-APPROPRIATE CARE IN THE NICU Page 8 of 8