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Discussion

Care Times

Our level 3, 46 bed unit is experiencing much frustration lately over not having designated "care times". Though nursing basically follows an 8-12-4 schedule for our little ones, there are a multitude of interdisciplinary team members that assess the child solely on their convenience. Specifically, surgery comes in to assess their babies during morning report time, undressing kids and interrupting report due to nursing having to intervene for alarms, etc. An hour later, they do the exact same thing with their attending! Several of us are really trying to improve this process and I am looking for some insight, suggestions. Thanks in advance!

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    It sounds like you need a coordinated meeting with some staff nurse representatives, your nursing leadership, members of the surgery team, and your neo team. If they are an hour apart, could they possibly meet in the middle? The developmentally appropriate are of the babies is just as valuable as "their time," so don't let them play that card with you. There is so much literature about clustered care, particularly for fragile neonates that it is not a matter of people not knowing about it; it's a matter of willfully ignoring it for their own purposes. If necessary, go even further up than your own leadership to the director and VP level, people do start to listen when people in the C-suite start talking, though it's sad that it often has to go that far.

    The best mindset to have is one where you all think about what you can do for these babies TOGETHER.

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    we also run into this problem at times on my unit. Usually surgery turns up around 6am but they only come through once with their whole clan (residents, fellows, attendings)...they've been known for extubating kids though so we keep a really close eye on them. Other disciplines come as they please neuro, genetics, opthamology, cardiology etc etc. I'ts definitely not possible to coordinate with all of them but usually kids are only seen by one specialty (though not always). If a kiddo is sleeping/sensitive though I will ask if they really have to touch them. Otherwise our cares are based on feeding schedules so if a kid is NPO or continuous feeds they're done 8-12-4 and if they're eating it's 9-12-3-6

    Sorry that probably doesn't help but know it's a problem elsewhere too.

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    We do a variety of care times ...9-12-3 and 8-11-2 for most of our po feeders... Occasionally we have 10-1-4 but I don't like those because often times it knocks parents out of the 7 pm feeding because our unit closes for shift change. Npo or continuous feeds are usually 8-12-4. NAS babies we usually do on demand or every 3-4 hrs.

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    Surgeons and docs assess our babies when they can. I won't really say it's at their convenience. Our docs are extremely busy. They are gentle with our kids. After they assess, I just re-wrap them and they go to sleep.

    Our level 2 kids are usually on a q3h schedule which starts at either 8, 8:30, 9, or 9:30. Our level 2 kids are on a Q2 vitals and hand on Q4 schedule, that starts at either 8, 8:30 or 9. With almost 60 patients and nurses always changing the babies schedules around, it seems like it'd be very hard for this to be coordinated.

    If I have an extremely cranky baby, I will ask them not to wake the baby up and usually they'll just tell me to call them when the baby is awake.

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    • Experts

    "You wake it, you take it!!"

    If that doesn't work, try to "help"--give them the #s they need, unwrap and rewrap the kid for them. Surgery's not as bad as Ophtho, tho--@ least imo.

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    We use an A B schedule, 8-11-2-5 or 9-12-3-6. We try to stagger the kids in the room. We also have 9-1-5. Our NPO or every 2 hour kids are done hands off care every 2 hours, monitor signs, etc every other feed. We have a small baby protocol in which our little kids aren't bothered but every 6-8 hours. For those big crabby babies, who are ALD, we don't touch until we see the whites of their eyes. We also have a rule, you can't change the kid's schedule once they are on it.

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