Celebrating Lactation in the NICU.
World Breastfeeding Week and National Breastfeeding Month in August gave us reasons to elevate the conversation about breastfeeding and mothers’ own milk as key ingredients for healthy infants and children. These lactation celebrations are a great reminder that “breastfeeding” can look different from family to family. While we typically see breastfeeding images that feature a mom cradling a baby to feed, the reality is that lactation can take many different forms depending on the mother and the baby’s unique circumstances.
For infants who are medically unstable or premature, direct breastfeeding may not be a good fit for meeting their nutritional needs. If you’re a NICU parent, that means breastfeeding – or parenthood in general, for that matter – may not look exactly as you envisioned it would.
AngelEye Health recently sat down to catch up with Kati Knudsen, PT, NPT, CNT, DCS, CLE, lead therapist, in-patient, pediatrics & NICU, at Providence St. Vincent Medical Center. Kati is a seasoned pediatric and NICU therapist with more than 20 years of direct in-patient experience. In addition to achieving a variety of neonatal and pediatric specific certifications and publishing numerous articles advocating for support for preterm and medically fragile infants, Kati is a leader in the national NICU community. She is currently a member of the Vermont Oxford Network Multidisciplinary Advisory Council, a current member and past co-chair of the Neonatal Therapy Certification Board, and a member of the AngelEye Health Clinical Advisory Board.
National Breastfeeding Month, a healthcare industry observance focused on building a landscape for breastfeeding support is coming to a close. This year’s theme, “Every Step of the Way”, was particularly poignant, calling for the industry to rally around the idea of a world in which every family is supported at every step along the infant feeding journey. At AngelEye Health, we are dedicated to elevating the NICU experience for families and their babies, offering a suite of next generation technology solutions designed to create maximum parental engagement, including feeding and nutrition.
When we were introduced to MilkTracker, we were particularly drawn to them because of their dedication to supporting clinical teams and parents in their feeding and milk management processes.
They say that the destination of a flight completely changes if the trajectory is moved by one degree. Earlier this year, one of my most exciting projects to date went live. As a project manager for most of my healthcare career, I have had plenty of ‘Go Lives’ but not one that has tugged on my heart strings like this one did; especially one story in particular (but we’ll get to that- hang in there with me).
From the very beginning, South Georgia Medical Center (SGMC) has been incredibly innovative in their approach. As a facility nestled in a community with a lot of military families, SGMC understood the importance of bridging the gap for family members who were deployed and would miss out on one of life’s most precious milestones- having a baby (or babies). Read how this innovative hospital is serving its community at home and afar…
My son was born at 28 weeks gestation and then spent 99 very long days in the NICU. It wasn’t until we had been home for several months that I started to process the trauma and isolation I experienced throughout his NICU stay. I survived his hospitalization by developing a fight or flight mindset in an effort to protect myself… I focused on every detail of his daily care and, at the time, failed to recognize how abnormal our overall experience was. As a NICU nurse myself, I openly had very high expectations.. I set boundaries for myself with the hopes of not becoming an overbearing, difficult parent…
Over the years, I have had the opportunity to provide emotional support to many mothers whose babies were admitted to the Neonatal Intensive Care Unit (NICU). As a NICU nurse, I would recite the same comforting words to each mother as she was discharged and forced to leave the hospital without her newborn. It was not until I had to leave my 28-week son, Theo, in the NICU that I fully understood the trauma of being physically separated from him. I was just starting to mentally and physically comprehend that I was no longer pregnant when I was discharged home on his sixth day of life. As I was wheeled through the lobby to go home, I sobbed as I held my empty, tender belly, longing to feel his gentle kicks again. Leaving the hospital without him was the most unnatural, painful, and confusing experience I have ever endured.
I couldn’t work around sick babies. I don’t know how you do it.” The infamous statement every neonatal professional has heard. Like many NICU nurses, I was called to this field of nursing before having babies of my own. For many years, I dreamed of having a baby; although, the thought of carrying a baby for nine months was terrifying.
It is the goal of all hospitals to make our patients and our communities healthier. As part of that, hospitals must become trusted partners in their patients’ pursuit of health and wellness. This begins with education. And when the patient is a child in the NICU or PICU, education becomes especially important for parents and families. From the moment a child is admitted to the NICU or PICU, parents need to feel as though their providers will go above and beyond to keep them informed and engaged.
To achieve this goal, hospitals must design and implement a comprehensive, parent, and family education program. But some hospitals don’t have the resources—staff, time, nor money—to focus on building this type of program. Such hospitals, along with those looking to enhance an existing program, can benefit by partnering with industry experts to help develop and maintain educational resources for parents and families of children in critical care units. When looking for a partner, hospitals should choose ones with the following capabilities.
Provide an online portal for easy access. Providing parents and families with paper-based educational materials is good, but the paper is easily misplaced or lost. Having the information available online helps ensure it is accessible when and where it’s needed from any internet-enabled mobile device. The portal should be available to parents and families from the moment of their child’s admission.
Offer a comprehensive document library. It is not uncommon for parents to “google” their child’s condition or care procedures, but the information they find may or may not be appropriate for the child’s specific situation. Having a single easy-to-navigate library of all pertinent information increases compliance and helps improve satisfaction as parents aren’t left to go searching for the information they need on their own.
Provide customizable educational materials. Canned educational materials can be sufficient in some cases. But for parents with children in the NICU or PICU, it is essential they have access to information customized for the child’s condition or procedure. This can reduce confusion, increase comprehension, and improve compliance and care experience.
Offer educational videos. Written information with heavy detail can be overwhelming for parents. Educational videos can improve clarity and retention. This can be especially effective for parents and extended family caregivers.
Enable pre-recorded, personalized videos. For more complex procedures, it can be beneficial for the hospital to record instructions with the actual child and parents before discharge. This allows more child-specific instructions, which can reduce anxiety, increase compliance, and improve outcomes.
Provide access to all family members. The rehabilitation period for children who have been under critical care can be lengthy. In these cases, it is likely that more than one family member will be helping care for the child at home. And those family members need easy access to all educational materials. They shouldn’t have to rely on others to provide the information they need.
Make materials available for the full recovery period. As time passes or caregivers change, it is easy to forget details about the care plan. Rather than guessing, caregivers need to be able to access the information they need for the full length of the recovery period. This helps improve care plan compliance and outcomes.
Enable reporting and tracking. Once a child has been discharged from the hospital, it is impossible to know if parents are following care instructions. The best educational solutions provide hospitals with the ability to track how often educational materials have been accessed and by whom. Having this information helps inform outpatient caregivers of potential compliance issues and can assist them in preparing for follow-up calls and appointments.
The Bottom Line
Studies show that when care plan instructions are understood at the time of discharge, patients are 30% less likely to be readmitted or to visit the ER. Partnering with a solutions provider to design a comprehensive education program for parents with children in the NICU or PICU can significantly impact quality outcomes and the care experience, both of which drive revenue, improve a hospital’s reputation in the community, and generate a healthier bottom line.
Millions of children are admitted to intensive care units each year for critical conditions, accidents, or surgeries. Besides the physical pain, the experience can cause emotional trauma as well. The fear, anxiety, and shock can be overwhelming for patients and their families. Often many families struggle with a sense of frustration and helplessness. Studies show that when parents and families are more educated about their child’s health conditions and care plans, they take a more active role in that care.
Millions of people enter the hospital each year for critical conditions, accidents, or surgeries. Besides the physical pain, the experience can cause emotional trauma as well. The fear, anxiety, and shock can be overwhelming. The patient’s family often struggles with a sense of frustration and helplessness. For families of neonates in NICUs, those feelings can be even more profound. Relieving these emotions requires hospitals to have a comprehensive program for educating patients and their families about the patient’s condition and care plan, providing as much detail as possible throughout the entire episode of care. But far too often, that doesn’t happen.
It’s not hard to remember a time when patients and their families were kept in the dark about what was going on. “Doctor knows best” was the motto and patients and their families just had to blindly trust the providers were doing what was best for the patient. But studies now show that patients who are more educated about their health conditions make better decisions about their care. And when patients and families make better decisions, it increases care plan compliance, a critical element for achieving quality outcomes.
Post-discharge patients are 30% less likely to be readmitted or to visit the ER if they understand their care plan instructions.
Yet even with this research, many hospitals and health systems still do just the minimal in the way of patient and family education. Whether due to a lack of resources, poor supervision, or just a weak culture, when hospitals don’t see value of sharing knowledge, patients suffer.
Designing an Educational Program
Following are three actions hospitals can take to begin designing a comprehensive education program for patients and their families.
Increase access to information. Transitioning from an acute care environment to the home can cause a great deal of anxiety, especially for patients who were being treated in a critical care unit or for their family caregivers. Between the time the patient receives discharge instructions to the time the patient arrives home, a lot of information can be forgotten. The result can be confusion on things such as when to change a dressing or how often to take medication. The latter is especially problematic as studies show that up to 40% of patients over 65 experience medication errors after discharge. The same study found that 18% of Medicare patients are readmitted within just 30 days after discharge due to complications. Patients and their families need a way to easily access that information whenever and from wherever they need it. Paper instructions can get lost or misplaced and verbal instructions can be misunderstood and easily forgotten. Having ready access from a mobile device or desktop gives patients and their family added confidence that they have the information needed to manage at-home care.
Create an online educational resource center. In the same vein as having access to information when and where they need it, patients need that information to be comprehensive, yet easy to understand. Documentation should be available to print for patients who prefer to have a physical copy of instructions. Information should be specific to each patient’s unique condition and care plan needs. If you don’t want to customize to each patient, you should at least customize to the condition. You also want to make sure the information is accessible my family members and that it’s available for as long as the patient is in recovery at home.
Providers and case managers should be able to view which documents or videos have been viewed and by whom. If a patient hasn’t viewed any documents, this may be a red flag for non-compliance. Caregivers can schedule follow-up calls to address any concerns or questions that may arise.
Create educational videos. Video has now become the format of choice for many educational programs, primarily because people retain more of what they learn. Reading step-by-step static instructions on a piece of paper can be confusing. But showing those same instructions in a video helps the patient or family member better understand the procedure. Even more beneficial is taking the video with the actual patient in the hospital setting prior to discharge. This can be especially effective for things like enteral feeding or treating wounds.
A Key Part of Your Quality Initiatives
Achieving and maintaining key quality criteria has a direct impact on a hospital’s HCAHPS scores, not to mention its long-term viability. And having a comprehensive education program for patients and their families is an essential part of that effort. Educated patients make take a more active role in their own health and are more likely to stay in compliance with their care plan. Hospitals benefit through better outcomes, increased reimbursement, and improved patient satisfaction.
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