Improving Time to First Parental Positive Touch and Skin-to-Skin Hold for Preterm Infants: A Quality Improvement Initiative.

BACKGROUND

Parental positive touch (PPT) and skin-to-skin (STS) improve bonding and decrease stress in parents and neonates.

PURPOSE: We sought to reduce the time to first PPT and STS for infants born <32 weeks by June 2023. We aimed to have 90% of infants to receive PPT by 24 hours of life (HOL), 75% of infants to be held STS by 36 HOL, and 100% by 1 week.

METHODS

Three Plan-Do-Study-Act (PDSA) cycles were completed. Interventions included parent advisor-led handouts/room displays, staff education with parent testimony and simulations, and kangaroo-a-thons. Preferred language, race/ethnicity, and unplanned extubations (UPEs) were recorded.

RESULTS

PPT by 24 HOL improved from 44% to 81% and was sustained at 74% ( P = .003). The time to first PPT also improved ( P = .02). Special cause variation occurred with PDSA 2. STS by 36 HOL improved from 50% to 81%, but drift was noted in the sustainability phase. The high baseline of infants receiving STS by 1 week persisted (98% to 93%). Non-intubated, inborn infants showed the most improvement in time to STS ( P = .001) and 100% were held by 36 HOL, up from 52% ( P = .02). There was an increase in the percent of infants held STS for the first time while intubated ( P = .04), despite an increased proportion on high-frequency oscillatory ventilation. There were no significant differences by language, race/ethnicity, or in UPEs.

IMPLICATIONS FOR PRACTICE AND RESEARCH: A parent advisor can enhance the impact of initiatives to improve PPT/STS. Ongoing efforts should continue to ensure equity in PPT/STS care and strive for 0 UPEs.