Learning Objective #1: verbalize the obstacles of caring for high risk infants in couplet care.

Learning Objective #2: list 3 key components in improving the care provided for high risk infants in couplet care.

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At UCSD Medical Center we have worked very hard to attain our Baby Friendly status and provide exemplary, family focused care to our Maternal Child Health population.  Due to our high risk patient population and goal of keeping mothers and infants together, we have a higher newborn acuity with greater nursing needs than would normally be seen on a post-partum floor.  Yet because of increased ratios, issues with nursing retention, and shortage of nurses it difficult for the nursing staff to remain current with evidence based practice in regards to care for these infants. 
 
I developed a project to address these problems and ultimately improve the care we provide to our high risk infants and their families. 
 
Projects encompassing evidence based practice:
·        Reevaulate Grasp system, acuity and staff ratios for high risk infants
·        Expand Newborn Standards of Care to encompass high risk population
·        Late Preterm (LPT) Committee: LPT Booklet, LPT caremap, LPT policies
·        Change in admission process to improve newborn transition, bonding and breastfeeding
·        Change in pain and procedures policies to decrease pain in newborns
·        Snuggler Program to assist nurses with the care of newborns
·        Journal Club for MCH staff
·        Night inservices
·        High risk infant resource book and flip cards
 
Anticipated outcomes over 18 months: (still in progress)
·        Increase MCH nursing satisfaction and comfort with caring for high risk infant population as evidenced by increase  satisfaction score of pre/post survey
·        Increase in patient satisfaction to the 90^th % by Press Gainey score
·        Increase nursing retention by 10%
·        Decrease readmissions of newborns from 4^th floor by 10%
·        Decrease eQVRs related to newborn care on the 4^th floor by 10%
·        Decrease length of stay of newborn boarders by 1 day