Debra Bingham, DrPH, RN, LCCE
In 2001 when Debra Bingham became the Maternal Child Health Director of Nursing almost 100% of the newborns at St. Luke's Hospital were separated from their mothers after only about 30 minutes of age. At Roosevelt Hospital approximately 80% of the newborns were also separated from their mothers at about 30 minutes of age. After education of all of the staff on the importance of keeping mothers and babies together quality improvement monitoring was started.
Step 1: The policies and procedures were re-written to ensure that vital signs were taken based on time of birth not on the location of the baby, a responsibility L&D nurses had not previously had.
Step 2: Quality Improvement monitoring was begun to determine where and when vital signs were taken to establish a baseline of current state.
Step 3: Graphic charts were used to record the number of sampled newborns who had vital signs taken according to the new policy. The policy stipulated that vital signs be taken every 30 minutes for two hours after birth, and the location of the baby recorded.
Step 4: On-going tracking and dialogue with staff identified barriers to keeping mothers with newborns. For example, L&D nurses were unsure where to record the vital signs, so a simple form was developed for recording heart rate, temperature, and respiratory rate. The L&D nurses were not expected to perform the newborn admission assessment. Policy was written to identify abnormal vital signs that would require transfer of the newborn and notification of a pediatrician. The nursing assistants in post-partum prepared and moved the newborn’s crib into the mother's room as part of admission. The staff were educated on the use of skin-to-skin and delaying the first bath for at least two hours to stabilize the newborn's temperature.
Step 5: On-going monitoring and discussion identified staff who were not compliant with the new change. The non-compliant staff were able to discuss their motivations and were provided with additional education.
Step 6: Celebrating success and on-going monitoring. The leadership staff and the nursing staff were able to celebrate the enormous change they participated in. While previously almost all newborns were separated during the critical first two hours of life, separation of mothers and newborns became an unusual occurrence. In order to ensure that the change became integrated, on-going monitoring occurred. St. Luke's day shift and Roosevelt's night shift were the slowest to adapt, re-confirming that change is context specific and the social component of change.
View Debra's CMQCC profile.
