P2.P303: Updates on Skin-to-Skin Care : A State-Wide Quality Improvement Initiative with Engagement of Families in the Neonatal Intensive Care Unit

Purpose/Objectives: Background and Significance: Emerging evidence suggests that early and frequent skin-to-skin care (SSC) and family-centered care (FCC) improve diverse outcomes of NICU infants and their families. Our statewide quality initiative aimed to expand FCC in each participating NICU by encouraging the medical team to involve families as essential caregivers. The primary intervention focused on increasing access to early SSC and establishing a culture of frequent SSC throughout hospitalization. The initiative, guided by FCC principles, aimed to reflect family needs and priorities.
1. PRIMARY Aim Statement: By June 2023, each NICU aims for a 20% increase in infants receiving SSC from at least one family caregiver within 3 days of clinical eligibility.
2. SUPPLEMENTAL Aim Statement: By June 2023, parental surveys aim to demonstrate a 20% improvement in the perception of FCC culture across all 4 domains in each NICU.

Design/Methods: Approach: We recruited a diverse ad hoc family team, representing recent and past NICU experiences, to inform us how families believed the medical staff could have supported better FCC. Led by the FPQC, the initiative engaged 33 NICUs in Florida and 1 in NY. We developed educational materials and an evidence-based toolkit, provided training, webinars, and technical assistance to the teams. Data collection included caregiver surveys, interviews, and medical record abstraction.
Inclusion Criteria: NICU Infants qualified if they were expected to require >5 days of care, were eligible for SSC per hospital protocol, had survived ≥3 days post-eligibility, and had engaged family caregivers.
Metrics and Methods: SSC measures included prompt initiation, duration, caregiver involvement, and documentation. We also tracked provider and caregiver education, competency training, and potential adverse events.

Results: Hospitals significantly improved several outcome measures, including prompt SSC initiation (49% to 59%) and breastfeeding rates at discharge (57% to 63%). Adverse events remained low (0-1.5% per hospital). Over 97% of NICUs implemented policies promoting/expanding SSC eligibility.

Conclusion/Discussion: Our initiative demonstrated the feasibility and benefits of involving families in SSC. Despite challenges, caregiver surveys and agreement with FCC domains increased over time. Collaborative healthcare teams achieved the highest rates of improvement. These findings underscore the importance of focusing on FCC to improve infant care nationwide.