Improving Our Unit/Organization

Mahler, F., Wijtzes, N., & Durani, S. (2021). 284 Improving patient care and saving clinician time with a new electronic NICU proforma. BMJ Paediatrics Open, 5, A84. https://doi.org/10.1136/bmjpo-2021-RCPCH.158

Mahler, Wijtzes, and Durani (2021) describe the development and implementation of a new electronic proforma in the NICU aimed at improving patient care and enhancing efficiency for clinicians. The initiative sought to streamline documentation, reduce duplication of effort, and standardize the sharing of clinical information. The electronic format improved the clarity and completeness of patient records, facilitated better communication among care teams, and significantly saved clinician time. The study highlights the importance of integrating user-friendly digital tools in neonatal care settings to support high-quality, efficient, and consistent clinical practice.

• Nurses can utilize the article by Mahler, Wijtzes, and Durani (2021) to grasp the benefits of implementing an electronic proforma in the NICU to improve patient care and workflow efficiency. The study emphasizes how adopting a standardized electronic documentation tool resulted in clearer, more consistent clinical records while also saving clinicians time. For nurses, this resource advocates using digital tools to streamline communication, reduce redundancy, and ensure accurate documentation of patient care. It is especially pertinent during electronic health record (EHR) optimization efforts, documentation training, and initiatives aimed at enhancing interdisciplinary communication and minimizing administrative burdens in high-acuity neonatal environments.

Quinones Cardona, V., LaBadie, A., Cooperberg, D. B., Zubrow, A., & Touch, S. M. (2021). Improving the neonatal team handoff process in a level IV NICU: reducing interruptions and handoff duration. BMJ open quality, 10(1), e001014. https://doi.org/10.1136/bmjoq-2020-001014

Quinones Cardona et al. (2021) detail a quality improvement initiative aimed at enhancing the neonatal team handoff process in a level IV Neonatal Intensive Care Unit (NICU) by reducing interruptions and the overall duration of handoffs. Through Plan-Do-Study-Act (PDSA) cycles, the team implemented structured interventions, such as standardizing the handoff format, designating quiet zones, and limiting non-urgent interruptions. As a result, the project significantly decreased handoff interruptions and duration without compromising the quality of information shared. The study emphasizes the importance of structured communication and environmental controls in improving handoff efficiency and patient safety in high-acuity NICU settings.

• Nurses can use the article by Quinones Cardona et al. (2021) as a practical guide to enhance the efficiency and effectiveness of team handoffs in a Level IV neonatal intensive care unit (NICU). The study demonstrates how structured interventions such as standardized handoff formats, designated quiet zones, and minimizing non-urgent interruptions can significantly reduce the number of interruptions and the overall duration of handoffs without compromising communication quality. This resource is particularly beneficial for nurses involved in shift-to-shift or interdisciplinary handoffs, as it provides evidence-based strategies to optimize communication and patient safety. It is most suitable during the implementation or revision of handoff protocols, staff training, and quality improvement initiatives focused on enhancing continuity of care in high-acuity neonatal settings.

Rubinos, L. H., Foster, C. C., Machut, K. Z., Snyder, A., Eddie, S., Hall, M., Casto, E., & Berry, J. G. (2022). Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays. Journal of Perinatology, 42(5), 624-630. https://doi.org/10.1038/s41372-021-01276-3

Rubinos et al. (2022) examine the risk factors associated with hospital readmissions among infants who experienced prolonged stays in the Neonatal Intensive Care Unit (NICU). By analyzing data from a multicenter cohort, the study identifies key predictors of readmission, such as complex chronic conditions, the use of medical technology (like feeding tubes or respiratory support), and public insurance status. The findings suggest that infants with greater medical complexity and social vulnerabilities are at an elevated risk for early rehospitalization. The authors emphasize the importance of targeted discharge planning and post-discharge support to reduce readmission rates and improve outcomes for this high-risk population.

• Nurses can use the article by Rubinos et al. (2022) as a resource to better understand and identify key risk factors associated with hospital readmissions among infants who have had prolonged NICU stays. The study highlights the importance of recognizing medical complexity, the reliance on medical technology, and social determinants such as public insurance as predictors of readmission. This information can guide nurses in tailoring discharge planning and post-discharge support to address these high-risk factors. The article is particularly useful for developing individualized care plans, educating families, or participating in quality improvement initiatives aimed at reducing readmissions and improving long-term outcomes for medically fragile infants. It is most appropriate for use during discharge planning, interdisciplinary case reviews, or when designing follow-up care strategies for high-risk NICU graduates.

Toole, C. , DeGrazia, M. , Andrews, T. , Bouve, M. , Pezanowski, R. , Cole, A. , Kourembanas, S. & Hickey, P. (2024). No Place Like Home. Advances in Neonatal Care, 24 (1), 46-57. doi: 10.1097/ANC.0000000000001134.

Toole et al. (2024) examine a comprehensive initiative aimed at improving neonatal transitions from hospital to home by implementing a family-centered discharge process in a Level IV NICU. The initiative sought to reduce readmissions and enhance caregiver confidence by integrating standardized discharge planning tools, fostering interdisciplinary collaboration, and ensuring early, consistent family engagement. Through education, personalized support, and clear communication strategies, the project facilitated smoother transitions and better preparedness for home care. The study underscores the significance of structured, collaborative discharge processes in promoting safer, more effective neonatal care transitions and improving outcomes for both infants and families.

• Nurses can utilize the article “No Place Like Home” by Toole et al. (2024) as a practical guide for enhancing the discharge process in the NICU through family-centered, interdisciplinary approaches. This resource helps nurses develop or refine discharge planning protocols that prioritize early caregiver engagement, structured education, and coordinated follow-up care. It is particularly beneficial when working with medically complex infants or families with high support needs, as it provides strategies to boost caregiver confidence and reduce readmission rates. The article is suitable for use during quality improvement initiatives, policy development, or training programs aimed at enhancing discharge readiness and ensuring safe, effective transitions from hospital to home.

Verklan, M. (2021). Patient Safety and Quality Care in the NICU. The Journal of Perinatal & Neonatal Nursing, 35 (3), 284-285. doi: 10.1097/JPN.0000000000000590.

Verklan (2021) emphasizes the critical importance of patient safety and quality care in the Neonatal Intensive Care Unit (NICU), noting that the inherent vulnerability of neonatal patients necessitates highly coordinated, evidence-based, and standardized care approaches. The article highlights the need to cultivate a culture of safety fostered by interdisciplinary collaboration, ongoing education, and a commitment to leadership. Verklan advocates for strategies that encourage accountability, reduce harm, and improve care outcomes through vigilance and systemic enhancements, establishing patient safety as a fundamental aspect of neonatal nursing practice.

• Nurses can use Verklan’s (2021) article “Patient Safety and Quality Care in the NICU” as a valuable resource to support best practices and promote a culture of safety in neonatal care. It can be incorporated into staff education and training programs, used to guide quality improvement initiatives, and referenced when developing or updating unit policies and procedures. The article also serves as a foundation for fostering interdisciplinary collaboration and aligning care practices with safety standards. Nurse leaders may find it particularly useful for advocating institutional support for safety initiatives, such as adequate staffing, access to resources, and systems for incident reporting and learning. This resource is especially suitable during staff onboarding, competency evaluations, the launch of quality improvement projects, or in preparation for accreditation reviews focused on patient safety.