|Organisation sharing the GOP||
Related practices from PaSQ database
|Hospital 12 de Octubre (Madrid). Division of Neonatology
Contact: Carmen Pallás [email protected]
Quality improvement project
|Implementation of Patient Safety initiatives / Activities
|Division of Neonatology at the “12 de Octubre” Hospital. It involves doctors, nurses, auxiliary nurses and families from inpatient newborns.
At national level specific training is being delivered in order to have certified healthcare professionals with capacity to spread the practice. More than 40_training_courses have already been delivered throughout Spain.
|-To_provide a suitable_environment for the_premature_baby/the_ill_newborn and their family that makes it possible a physiological_and_emotional_development similar to the intrauterine_one.
-To_provide the Neonatology_patient a type_of_care that makes_it_possible not only the recovery from his pathology but also a suitable_and_comprehensive development.
-To_favour the emotional link between the_parents_and_the_newborn while the parents recover their role_of_caregivers.
|-Premature babies and their families
-Ill newborns and their families
|-Training and certification of at least 10% of healthcare professionals (doctors and nurses) working in the unit.
Each professional’s training takes around 15 months. Then at least one of the professionals trained must be certified as trainer (the trainer’s training takes around 2 years)
All the process takes around 5 years.
– In the meantime, the trainers (in our case one from the Boston center and another from Argentina) come to our unit 8 times and successive APRA evaluations are carried out in order to check the environmental changes recommended (light, noise, handling protocol, family care, pain treatment, unit open 24 hours to parents… and the most important: the ability to observe and understand the baby’s signals in order to adapt care to its needs.
|5 years are required to achieve the centre’s NIDCAP certification after the NIDCAP International Federation’s evaluation, since it is necessary to certify 10% professionals, to change attitudes and to make structural adjustments.|
|Implementation tools available|
|-Specific training and evaluation guidelines
-External assessments and audits throughout the implementation process
-Patients and professionals’ satisfaction survey
|-Each professional’s certification costs like a master’s degree (5000 €). Total cost of training around 60,000 €
-Environmental changes: around 200,000 € (doors, window shades, refurbishment in waiting rooms and parents rooms, armchairs, floor changes, lightning…)
|Method used to measure the results|
|Surveys, unit performance indicators, mortality, length of stay|
|We haven’t finished collecting 2012 information yet (there are still inpatients born in 2012) but the 2011 data on survival of newborns under 1500g was excellent (93%) and the length of stay decreased.
The professionals’ satisfaction survey has been carried out. The results have been published. The level of satisfaction is very high and there is a clear improvement in the perceived quality.
A pilot of the parents’ survey has been performed (very high level of satisfaction) and we are about to carry out the definitive one.
|Analysis of the results|
|We cannot assure that NIDCAP is the only reason for the improvement but since its implementation results are increasingly better.
We are going to carry out a longitudinal study comparing the results after two years in a cohort of NIDCAP newborns and another cohort without NIDCAP. We will mainly study the emotional adjustment and behavioural disorder. This study is under design.
|Did you find implementation barriers?|
|Please describe implementation barriers|
|To change attitudes is complex. An analysis of barriers has been performed (submitted for publication) and the most important was coordination and communication between different groups of professionals (doctors, nurses, auxiliary nurses) and the perception that more professionals are needed.|
|Describe the strategies used to overcome the barriers (If needed)|
|To intensify training and meetings between different groups of professionals; to open new communication channels, to use electronic media to improve communication; to create groups and nets.|
|Other information about the GOP that you would like to add (Link or attached document)|
|Mosqueda R, et al, Staff perceptions on Newborn Individualized Developmental Care and Assessment Program (NIDCAP) during its implementation in two Spanish neonatal units, Early Hum Dev (2012), doi:10.1016/j.earlhumdev.2012.07.013|