Skin-to-Skin Care in the Level IV NICU: A Quality Improvement Project

Skin-to-skin care (SSC), also known as kangaroo care, is a simple intervention that involves placing a naked, or nearly naked, newborn in a prone position on the chest of the parent. This practice was originally devised in the late 1970s as a means of preventing hypothermia in premature infants. Since that time, multiple studies have supported its many benefits to both the newborn and parents. Some of these proven benefits include: physiological stability, better breastfeeding, and improved neurodevelopmental outcomes. Parents' stress levels have been shown to decrease and they also experience greater satisfaction related to the NICU hospitalization when SSC was practiced. The newborn intensive care unit (NICU) at Primary Children's Hospital (PCH) in Salt Lake City, UT is a level IV NICU within an urban children's hospital serving a large swath of the Intermountain West region. The neonatal population in this setting consists of medically complex infants with conditions that require interdisciplinary specialty teams of healthcare providers. While SSC is frequently implemented following birth of infants receiving care in lower acuity NICUs, it is not routinely practiced in the NICU at PCH due to multiple perceived barriers, including infant acuity. Ironically, these extremely ill infants may be most in need of the benefits that SSC provides. The objectives of this DNP project were to: (1) determine the prevalent attitude of staff members regarding SSC, (2) develop a clinical practice guideline (CPG) for SSC within a level IV NICU, and (3) to increase the practice of SSC in the NICU at PCH. Skin to skin care attitudes and practices of the PCH NICU staff were determined through a questionnaire designed to measure the current use of SSC, as well as assess the prevailing attitudes of staff regarding the practice. A CPG was developed using current evidence and questionnaire results. The CPG was submitted to PCH and is currently pending approval for inclusion in department protocols. In order to expand SSC practices, the staff received education regarding the benefits of SSC, and methods to overcome nurses' perceived barriers to its use. The infant's SSC eligibility status was incorporated into daily multidisciplinary rounds. Increased awareness of SSC should result in increased frequency of the practice.