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Learning Objective 1: Identify strategies to achieve immediate skin-to-skin contact between mothers and their newborns.
Learning Objective 2: Discuss the relationship of sustained project focus and unit culture change during a structured quality improvement implementation project.
Placing mothers and infants skin-to-skin immediately after birth improves bonding, temperature and blood sugar stability, and breastfeeding initiation (Ferber & Makhoul [2004], Moore et. al. [2009]). Skin-to-skin contact remains difficult to integrate into the task-focused nursing culture at Mercy San Juan Hospital in California, where approximately 2,700 births occur annually.
Activities/ Evaluation Methods:
The quality improvement method used at this hospital was MAP-IT:
Mobilize: An interdisciplinary project leadership team was formed and sustained. The team included the birth center nurse manager, educator, Neonatal Resuscitation team respiratory therapist, and a lactation consultant.
Assess: Skin-to-skin frequency and RN practices and knowledge were assessed pre-, during- and post-implementation. Frequency of timed skin-to-skin contact was recorded in patients’ electronic health records.
Plan: The team developed a plan with short and long-term objectives summarized using a logic model.
Implementation: Nursing and respiratory staff members were educated about benefits of mother/ infant skin-to-skin contact, strategies to implement the practice, and the process for accurate documentation.
Track: Monthly data were evaluated and project adjustments made. Graphs provided visual information to staff and leadership about the steady improvement in accurate documentation and rates of skin-to- skin contact.
Results: Accurate skin-to-skin documentation increased from 40% to 90% over a 6-month period. Skin-to-skin contact for 30 minutes or more increased from 58% to 83%. Other benefits included development of the author’s ability to lead quality improvement I initiatives.
Conclusions: A multidisciplinary team with a comprehensive plan and sustained focus led to more frequent skin-to-skin contact.
Next Steps: Sustaining improvements and expansion of the project to reduce separation during the inpatient hospital stay are planned.
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