P3.D079: The NICU Book Project: Challenges of an Improvement Project

Purpose/Objectives: Studies conclude infants in the Neonatal Intensive Care Unit (NICU) with greater language exposure have better neurodevelopmental outcomes. Research suggests parents reading to premature infants more than twice a week correlates with higher cognitive development scores by the age of 2, even after controlling for variables of neonatal/maternal health and socioeconomic status. Reading in the NICU can help parental bonding and increase likelihood of reading after discharge. The aim of the project was to increase language exposure to NICU patients by reading at a single level III community NICU by 20% from June 2023 to June 2024.

Design/Methods: Using continuous improvement methodology, a project was created to identify ways to increase language exposure through reading in the NICU at Cottage Hospital. Reading to NICU patients is not currently the standard practice. Surveys of parents and nurses were performed randomly by resident physician from June 2023 to November 2023. NICU nurses were asked how often they observed parents reading to their child while on their 12-hour shift. Parents were asked if they had read to their child in the past 3 days.

Parents were provided new books weekly through funding from Children’s Miracle Network. A bookmark in their preferred language (English or Spanish) with brief benefits of reading was also provided. Surveys were then repeated.

Multidisciplinary NICU staff were surveyed re: barriers to parents reading to their infants in the NICU.

Results: Pre-intervention, 4 of 28 nurses surveyed had witnessed parents reading on their last shift, and 6 out of 25 parents surveyed had read to their child at least once in the 3 previous days. Post-intervention, after books were provided weekly, 0 out of 10 nurses had witnessed parents reading on their previous shift and 0 out of 5 families stated they had read to their child in the last 3 days.

Conclusion/Discussion: The first PDSA cycle with the intervention of providing books did not demonstrate an increase in reading to NICU patients. However, it did provide the opportunity to further break down the problem. Multidisciplinary NICU staff were surveyed regarding barriers to parents reading to their infants. Some factors were amenable to intervention while others were not modifiable. Environment, severity of illness, parent literacy, expectation and benefits of parents reading in NICU, and book availability. Based on these survey results, our next PDSA cycle intervention (in progress) is to have staff discuss and invite parents to read to their infants during multidisciplinary NICU rounds.

In progress: Reading to NICU infants increased by % in 12 months. Post-PDSA cycle #2 interventions, X out of XX nurses had witnessed parents reading on their previous shift and Y out of YY families stated they had read to their child in the last 3 days.