068 - All Care is Brain Care: Improving Skin to Skin by 72 Hours of Birth
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 68.4017
Mary E. Pease, Perelman School of Medicine at the University of Pennsylvania, Berwyn, PA, United States; Gordon Chang, Children's Hospital of Philadelphia, Wynnewood, PA, United States; Gwen Kay. Bretz, MAIN LINE HEALTH, Ridley Park, PA, United States
Medical Director of Newborn Medicine at Main Line Health Children's Hospital of Philadelphia Bryn Mawr, Pennsylvania, United States
Background: All Care is Brain Care is a four-year long quality improvement collaborative through Vermont Oxford Network (VON) aimed at decreasing the rate of severe intraventricular hemorrhage (IVH), defined as grade III and IV. Main Line Health (MLH) is part of the Children’s Hospital of Philadelphia Newborn Care Network (CNBCN) for which this is a network initiative. MLH is composed of two level III Neonatal Intensive Care Units (NICU) and two level II NICUs. There is significant morbidity and mortality related who neonates who develop severe IVH1. The first year is focused on the pre-admission and golden hour phases of care. Our focus was improving rates of skin to skin within the first 72 hours of birth using the Model for Improvement methodology with Plan Do Study Act (PDSA) cycles. Objective: Four-Year
Aim: Reduce the rate of severe IVH, defined as grade III or IV, in the MLH NICUs to < 5.0% by December 31, 2026 regardless of race, ethnicity, or gender. Year One
Aim: Increase the percentage of infants who achieve skin to skin within the first 72 hours of birth by 10% above baseline (baseline 51%) in infants Design/Methods: The Model for Improvement using PDSA cycles was used over a 1-year period. The balancing measure was complications during skin to skin. The process measure was proper documentation in Epic EMR flowsheets of the first skin to skin encounter. PDSA cycles focused on education of nurses, the clinical team and parents about the importance of skin to skin. A Skin to Skin Protocol was developed and implemented. An appendix with photographs and detailed descriptions of proper skin to skin technique was designed. Skin to skin transfer simulations were performed will all nursing staff. Results: There was special cause improvement in the overall rate of skin to skin at MLH from baseline 51% to 91.9% during the intervention period (Table 1). Rates of complications remained low and rates of proper documentation increased (Graph 2).
Conclusion(s): The interventions provided significant improvement in the rate of skin to skin by 72 hours of birth in the Main Line Health system. Each hospital had unique challenges to implementing change. Aligning all hospitals with protocols and guidance allowed for success.
