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The influence of improved communication on Press Ganey Scores in the NICU

Introduction

Winnie Palmer Hospital for Woman & Babies is a 285-bed facility, the largest such facility dedicated exclusively to children and women in the United States. It has has one of the most experienced labor and delivery units in the nation, delivering over 12,000 babies annually. The Alexander Center for Neonatology is the fourth largest neonatal intensive care unit (NICU) in the US and it is designated a Regional Perinatal Intensive Care Hospital for the State of Florida, accepting referrals of high-risk obstetrical patients and their infants.

The Problem

Any baby’s admission to a NICU is a highly stressful and emotional time for the parents. Real-time, accurate and supportive communication between parents and NICU staff is a vital part of the support given to the mother and father to help alleviate their emotional burden.

In a review article published in 2012, Lanlehin made the following observations and recommendations regarding communication in the NICU:

  • Parents value the nurturing and sharing aspects of communication.
  • Provision of accurate and timely information is important to parents on the neonatal unit.
  • Updating staff on the tenets of family-centered care may improve the quality of neonatal information provision.
  • More studies need to be carried out on how to improve confidentiality when providing information to parents of sick babies.
  • Fathers who are absent when important information is provided about their sick  baby may benefit from audio recorded information.

The Solution

Orlando Health, the parent organization of Winnie Palmer Hospital has, as part of it’s mission and vision statement, a promise to provide “Superior Communication” when caring for patients by keeping everyone informed about and involved in their care plan. With this in mind, the NICU adopted a new and innovative technology in order to improve communication and keep families informed during the long days and months that premature babies often require to spend in hospital. They aim to support the bond between parent and infant as will as between care-giver and parents during their NICU stay. Said Ann Diaz, RN, Nurse Manager, “In the NICU, parent and staff communication is a top priority in instilling confidence and trust and in building a safe and collaborative environment for care giving by parents.”

EASE is a mobile app that allows nurses in the NICU to send HIPAA compliant messages in the form of texts, pictures and videos to family members.  It is available for free in both Apple (iOS) and Android formats. Utilizing 256-byte encryption, messages are secure in transit and at rest, disappear after 60 seconds of screen time, and are not stored on either the sending or receiving device. Parents have the ability to add family and friends to receive the updates. Once a baby is “admitted” to the EASE program, a unique QR code is generated and then scanned to make an initial connection. In order to send messages, the nurse simply scans the bar code on the medical wrist band of the baby. The app generates a customizable survey where specific questions can be asked and feedback received regarding the parents experience during the NICU stay.

Results

Implementation and adoption of the program was quickly and enthusiastically embraced by the nursing staff. Each NICU “pod” which has 10-14 babies, has an iPad dedicated to the EASE program and nurses send an update a minimum of three times daily at the start of a new shift. NICU nurse Emily Forbes, RN related “everybody is eager to get on board and looks forward to the updates everyday.  I think, if anything, it’s been something fun to add to my workload”.  Added Roxanne Baggott, RN “for many of our parents, especially when they leave, it’s very traumatic for them. Being able to send a picture every morning is not only phenomenal for them, but rewarding for us too”.

Following a six-month pilot program using the EASE mobile application, Press Ganey scores were analyzed and demonstrated a steady increase as the program became more widely adopted and utilization increased. Since implementation, Press Ganey Patient Experience Scores have increased 4.4% and are now over 90%, well above the Press Ganey 50th percentile average of 88.4% (see Figure 1).

Response from parents has been overwhelmingly positive. “I can tell you that the EASE app was a huge factor in me not getting postpartum depression” said Baby McNeil’s mom, whose premature baby spent over 3 months in the NICU.

Another survey comment, “it means the world to us, it shows they really do care”.

Utilization of the app has exceeded the target of 75% and the expectation is now that all babies will be enrolled to enable continued communication between physician, nurse and family through the entire NICU stay.

 

 

References

Lanlehin R.  Factors associated with information satisfaction among parents of sick neonates in the neonatal unit. Infant 2012;8:2

Franck LS1, Axelin A. Differences in parents’, nurses’ and physicians’ views of NICU parent support. Acta Paediatr. 2013;102:

Wigert H1, Dellenmark MB, Bry K. Strengths and weaknesses of parent-staff communication in the NICU: a survey assessment. BMC Pediatr. 2013 May 7;13:71.

Liz Jones.  Effective nurse parent communication: A study of parents’ perceptions in the NICU environment.

How EASE works in the NICU

 

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