Initial data show PEACH helped improve kangaroo care at Mott 

by Michael J. Happy / PEACH Web Project Manager

Kangaroo care (KC) is described by the World Health Organization (WHO) as infants being held by a caregiver with skin-to-skin contact. Research shows that KC is vital to ensuring optimal immediate and long-term cognitive, social and behavioral outcomes for children born preterm or with very low birth weight.

A recent PEACH study found that babies in the neonatal intensive care unit (NICU) at C.S. Mott Children's Hospital received less than an hour a day of KC, substantially less time than recommended by WHO. Worse yet, there was a wide gap between KC of White babies and Black and non-White babies.

Rachael Pace, a senior clinical information analyst in the Neonatology Division at Mott, is the project lead on the study along with Paris Ekeke, M.D., a neonatologist. Pace said it's important to follow the PEACH approach of finding systems-level approaches to eliminating identified inequities instead of pointing fingers.

"Finding a racial inequity in our data was disappointing and uncomfortable, especially being a witness to the meaningful work our doctors, nurses and staff deliver every day," Pace said. "With the help of PEACH, it was clear that the inequity was not a result of a single person or discipline. A systems approach to closing the racial inequity gap would be the most sensible for successful change. Rarely, if at all, will there be that one thing that will fix a complex problem."

This project is one of four PEACH projects in the quality improvement stage, and some early work appears to have made a significant difference: Preliminary data show that KC for White and Black babies is nearly identical now, and each group exceeds 60 minutes a day. Although more analysis of the data is necessary -- a new KC dashboard is due for launch (April or sooner) and will be used as a tool to track progress of the work for the entire NICU -- Pace points to the successful consensus and support of unit and hospital leadership on the need for change as crucial to this work.  

"Specifically looking at kangaroo care, our equity numbers are not good," said Kimberly Monroe, M.D.,  M.S., chief clinical officer for Mott, who attended a stakeholders meeting that kicked off the QI process back in July. "We need to improve kangaroo care overall, for all families, but we really need to make sure that the Black and non-White populations, those little babies, get more kangaroo care."

Said Pace of that stakeholders meeting: "Having a cross section of a care team at the table revealed various attitudes and beliefs about the care we aimed to improve. We sought subject matter experts in response to safety concerns."

One of those safety concerns is the danger of unplanned extubation -- the removal of an endotracheal tube from a baby's airway -- during KC, so a prompt quality improvement step was to bring a NICU-based committee, NeuroPro3, on board to share their expertise and recommendations for a standardized process to mitigate that risk, leading to a greater confidence level in providing the opportunity for KC.

"We, as nurses, know KC is a lot of work to do and how important it is for patients and their families," said Lauren Hodges, R.N., B.S.N., a nurse in the Mott NICU. "We are excited to make KC a process that is more of a standard part of the great care we provide. It's worth the work."

Another problem revealed during the stakeholders meeting involved messaging; parents simply didn't know how important KC is to the development of their child. Antenatal consults with neonatologists now include discussion of the value of parental participation in KC in the NICU. To further evaluate the effectiveness of changes to messaging, Pace said families soon will be interviewed to determine if the information provided really hit home.

"Feedback from families will guide us in our next steps to refine our messaging," Pace said. "We still have more work to do, but we are excited to keep going."