NICU Rooming In before discharge

MegNeoNurse · Mar 14, 2006

I apologize in advance for not being able to answer all of your questions in depth as far as teaching/safety prior to rooming-in.

We allow our NICU parents to room in with their soon to be d/c'ed baby in a postpardom room (same floor, 30 or so yards down hall and around corner from nicu.) If baby is going home on a monitor (apnea, hr etc) the parents would have received that teaching in advance, same with O2 nasal cannula. Otherwise, no monitors on baby. The feedings are up to the parents, though they keep breastmilk in the nicu fridge and prepare milk/formula for feeding in nicu. Usually babies that are about to be d/e'ed are on PO feeding schedules anyway. We do ask parents for a brief report of baby's night, though if there is a problem they are on the phone right away with us. No additional consents for rooming-in. As far as safety, pretty much make sure the baby is put down to sleep on his/her back and no stuffed animals etc in bassonett.

Hope this helps some!

Jerico, BSN, RN · Mar 18, 2006

I am on the parent education committe in our NICU. I am searching for guidelines that other NICU's have in regards to parents rooming in with their infant before discharge.(in a sperate room close to the unit, does have a monitor) What education do you provide them, what do you expect from them, what safety issues do you address with them, what about documentation, feeding schedules, do you have them sign a consent? I can go on and on but any information would be appreciated.
Thank you
angellady24

We require our parents to room in for one night, especially those who appear to not have the "highest sense of parental responsibility" i.e., the teen mom of a 4.5 pounder on O2. We encourage all parents to room in, but it is not required. We do not have consent forms. Whatever the baby is on going home with the parents/caregiver must show ability to perform necessary maintenance and parameters of safety. We have teaching sheets the parents are given far before the rooming in night(s) - such as how to gavage feed, use the apnea monitor, gastrostomy tube feedings, etc. We allow the parents an extra night or so if they seem to be unsure of themselves or request extra time to "learn" or get a feel for their infant.

Our rooming in rooms are less than 30 feet from our NICU. The parents are asked to keep a "vitals sheet" through the 24 hours - to document feeds, diapers wet and dirty, vomiting, length of feeds, amount of feeds, and issues noted with questions to ask before discharge.

We also require parents to have prescriptions filled BEFORE baby discharge. They must then bring the med in, and we make sure the parents know how to perform administration of the meds.

We do alot of teaching...not just for the ones who room in, but for all NICU discharged babies and parents. We have a list we must check off...such as the corificeat test, emergency procedures at home, who to call and when, feeding, diapering, safety at home, sibling issues, monitors, etc.

Deidre Shiobhan · Mar 24, 2006

My unit do not room in all infants that are fit for home. Only those that requires o2 therapy, monitors at home, suctioning, trach care will require rooming in 1st before sending them home. The room will be located at the same level of the SCN and a nurse will be assigned to take charge should the parents need help or if there's any emergencies. The nurse will not be in the room but the parents can call her thru the phone should they need help, normally we allow the immediate caregivers such as parents/ grandparents and even the domestic helpers to stay. ( it's not surprised that domestic helpers are also involved in the care in my country )

They will normally room in for 2 days or so but intensive training will be done prior to rooming in because we want them to feel confident and comfortable just like how they are going to manage the baby at home. No consents are required but we'll inform the parents when is the day the baby will be discharged so that rooming in can be done almost the last week before the baby is sent home.

Hope this information is useful.

jnsatc · Apr 5, 2006

we have 9 transition rooms on our unit that parents can room in with their babies. every baby is on a central monitor, but the parents are heavily encouraged to provide all personal care to their baby. We have a rooming in sheet that the parents can fill out the temperature how much the baby ate, if the baby had a wet or dirty diaper. Most of our discharge teaching such as careseat test, ALGO, Hep B, CPR and second hand smoke video is shown in transition. Parents are not required to stay 24/7 (we do realize that they have jobs and other kids) and no consents are needed. Our most stable chronic kids go their and kids most ready for discharge, so we've had kid occupy a room for a couple of days to several months, theirs no hard rule about the amount of time you can be in transition. Every nurse that works ICU works in transition and intermediate, but we have nurses that only work intermediate and transition, which is aggravating when you are trying to follow your primary through to discharge. We make sure all parents are comfortable with all aspects of their babies care before we discharge, it all seems to work pretty well

NicuNightRN · Apr 5, 2006

We do not require rooming-in for all babies, but many parents request it. If the baby is going home on O2, it is required. It is written as an MD order and they must write with or without monitors. We have one rooming-in room on the same floor as the NICU, just down the hall from the unit. This room has a monitor connected to the front desk of the unit. If the baby can room-in off monitors, they can use the postpartum rooms on the floor below us. A parent teaching checklist is started at admission, but we do require certain parts to be completed prior to rooming in, such as use of bulb syringe. There's a code button in the room for an emergency, and we also give the number of the bay where that baby's nurse is working and the number of the front desk. Parents are responsible for all care of the baby and we give them a clipboard to keep track of feeds, wet/dirty diapers, etc. We usually prearrange a time to bring the baby back to the unit if he or she has labs due, and we'll weigh at this time too. No additional consent is needed to room in, and parents can room in more than once provided the space is available.

BittyBabyGrower, MSN, RN · Apr 6, 2006

We don't have anywhere on our unit for the moms...we used to but they turned it into a storeroom There are moms that we tell that they have to come in and spend at least 4-5 feeds with the baby. They have to do all the care, feed the baby, give meds, etc. All parents have to have the prescriptions filled before we will release the baby. We do have rooms that the moms can stay in on another floor and sometimes if postpartum isn't busy they will let us use a room on their floor. Teen moms CAN NOT stay by themselves overnight....we have had way too many incidents with them.

elizabells, BSN, RN · Apr 27, 2006

I'm not 100% sure on the actual policy, but we have several rooms called "launchpads" (cute, huh?) that are basically like nice hotel rooms - big bed, bathroom with shower, dresser, desk. Families stay in them just the night before discharge. No monitors, and only nursing contact is if mom calls to the pod. I know babies that have been in the launchpad, and babies that haven't. Unfortunately, I'm not sure what the criteria are. I can find out, though.

lovemyjob · May 5, 2006

I am not sure on our criteria either, but we def keep our kids on both the home monitor as well as a remote view monitor so we can determine that mom woke up to the alarms and also for our own peace of mind. Mom does all of the care otherwise, with staff a pjhone call away (and a few doors)

The idea of a sheet for mom to write down feedings/diapers is a great idea. We are really just asking the parents when we go on to check on them. I will ahve to make a suggestion to the ed committee.