OT/PT/ST in the NICU

[nicubee]

I was wondering how many of you work in NICUs with OT/PT/ST on board? Our 56 bed NICU has an OT and ST present on the unit daily. A few years back, rehab had 3-6 infants on the caseload at a time. Since then, the rehab referrals have increased steadily, and now specific infant groups receive blanket orders. With this growth, I have observed that while some nurses are quite interested in promoting developmental care and cue-based feeding practices, many are still indifferent or even resentful of the rehab presence and recommendations, more comfortable with the "traditional" medical model of care/feeding. I have even heard parents comment on how the nurses and therapists seem to do things (like positioning) differently.

How do you weigh in? Do you see OT/PT/ST as developmentally necessary services for the general NICU population? Who should take the lead on developmental care and cue-based feeding?

[Shelby029]

Interesting subject. I am not a nurse but I find this to be a neat subject! Hope you get some good replies!

My unexperienced opinion would be that the knowledge of the nurses and rehab therapist put together would have wonderful outcomes for the infant/parents as long as there weren't "turf wars." In general it always helps to have others with different opinions look at things, it is easy to miss things when busy so the more eyes the better!

[catlover314]

Our 18 bed Level 2EQ unit has a developmental specialist who is also a PT. She does PT evals as well as NIDCAPs, infant massage and a plethora of other services. We have an ST who comes in regularly though she is not unit based. Our unit places high emphasis on developmental and family centered care. Some of it is mandated by the state, but historically there is also internal dedication to those concepts. We are lucky. Our PT and ST are leading the cue based feeding changes, and our PT/Dev Coordinator works with the lead NNP to keep us on track developmentally.

[RainDreamer, BSN, RN]

Our PT/OT gals are AWESOME! We're all (nurses and the therapists) pretty much on the same page with positioning, so we don't really have any problems there. They're also a great resource for the parents. They'll come in and do tons of one on one teaching with the parents.

The STs are great too, but sometimes I think they get ST involved and it's not really needed. I've seen a resident write for a speech consult on a kid that wouldn't eat, yet he was only 34 weeks! When the speech consult is warranted and the kid truly has an oral aversion and needs extra help, then yes, they're wonderful in helping us find a nipple/bottle system that works for that particular kid. Or if it's a kid that they think may be aspirating, they'll advise for an MBS and figure out the consistency of what we need to thicken the feeds to. They've also been a big help in getting our docs to transition over to infant-directed feedings (whereas before they'd write an order for a specific feeding schedule - PO each feeding, PO every other feeding, etc; so now it's nice to just have a "infant directed feeding order).