Implementing an Early Mobility Protocol in a Newborn Intensive Care Unit for Infants with a Corrected Gestational Age of 37 Weeks or Greater: A Needs Assessment

Neonates cared for in newborn intensive care units (NICUs) who have lengthy hospital stays compounded with other risk factors, including prematurity, low birth weight, and mechanical ventilation, are at an increased risk of delayed developmental outcomes. Current literature suggests that implementing mobility and developmental care can improve these outcomes. Local Problem: A 51-bed NICU does not have a formal mobility guideline for neonates with a corrected gestational age of 37 weeks or greater to help guide providers in mobility care based on acuity/illness. Approximately 90% of newborns discharged from a local level IV NICU and 50% from a level III NICU leave with either a referral for outpatient therapy or early childhood intervention. There is a need to assess if a mobility guideline is feasible and usable in this unit. Methods: A needs assessment was conducted at a Level IV NICU in Utah to evaluate the feasibility and useability of a NICU mobility guideline. Interventions: Pre- and post-guideline surveys were emailed to interdisciplinary staff caring for NICU patients to assess the feasibility and potential usability of a mobility guideline. A strengths, weaknesses, opportunities, and threats (SWOT) analysis, which included staff interviews and discussions, was conducted to assess the need for mobility guidelines and current processes and resources to identify facilitators and barriers to guideline implementation. The Plan-Study-Do-Act (PDSA) cycle was integrated into the SWOT analysis to engage with participants and make rapid cycle changes as needed regarding the needs assessment and the mobility guideline. Results: Survey responses from n=59 participants (16.7%) before the guideline and n=16 (4%) responses with the distribution of a draft of the mobility guideline were collected. With the distribution mobility guideline draft, out of 16 respondents, 13 (81%) respondents revealed guideline useability as easy to read. Fourteen (87%) responded that it was feasible to implement the guideline and could be implemented easily. The SWOT analysis revealed organizational strengths (willingness/readiness of staff) and weaknesses (time restraints and frequent onboarding of new staff). Conclusion: This needs assessment using surveys, interviews, and discussions, and the development of a SWOT analysis demonstrated the usability and feasibility of a mobility guideline.