NACHRI%20Fall%202009%20A%20Carefully%20Calibrated%20NICU%2

A Carefully Calibrated NICUPresented to:

NACHRI A l C f 2009

NICU

NACHRI Annual Conference 2009

October 12, 2009October 12, 2009

NACHRI Annual Conference 2009A Carefully Calibrated NICU

Children’s National Medical Center - NICU

• Neonatology Program is ranked in the top 10 in the

t di t U Scountry according to U.S. News

• The region’s only Level III C • 54 beds• 205 sf patient rooms• 36,000 total sf• PVC and DEHP free


Existing NICU before Move In 2009


NICU Program ReviewGUIDING PRINCIPLES FOR DESIGN:

• Family-Centered Care: Parents as Partners– Bedside space – meeting clinical & family needs– Family support – waiting room rest rooms in unit consultation rooms– Family support – waiting room, rest rooms in unit, consultation rooms– Breast-feeding room– Private rooms

• Clinical Excellence: World Class Care – Bedside space for high tech equipment while meeting family needs

Developmentally supportive care environment noise and light reduction– Developmentally supportive care environment – noise and light reduction– Surgical support on the unit – procedure room

• Education & Research needs: a design to support new, innovative educational programs & clinical research

– Educational session on unit – ICU, difficult to have staff off the unit– State-of-the-art simulation training for RN, residents, fellows– Educational training areas/conference room to accommodate collaboration with U of Maryland

nursing program– Space for research equipment – NIRS, aEEG

• Design that meets the national standards for NICUs : AAP Perinatal NICU GuidelinesDesign that meets the national standards for NICUs : AAP Perinatal NICU Guidelines

• Competitive design to regional NICUs

• Competitive design to the top 10 children’s hospitals, i.e., a design that will make us a national leader in neonatal medicine


NICU Program Review

CNMC NICU USER GROUP:

Billie Short, Division ChiefJesus Cepero, Critical Care Nursing DirectorTara Taylor, NICU ManagerLinda Talley, Director Nursing Systems Lisa Williams, NICU Clinical CoordinatorsLisa Zell NICU RN representative from Resource CouncilLisa Zell, NICU RN representative from Resource Council Maureen Maurano, NICU RN representative from Practice Council Brenda Lewis, NICU Advanced Practice Specialist An Nguyen-Massaro, Neonatology FellowK. Rais-Bahrami, Neonatology AttendingLouis Scavo, Neonatology AttendingShannan Eades, Pharmacy Anne Marie O’Donoghue, NICU Parent Advisory Council Elizabeth Ottaway, NICU Parent Advisory CouncilKarla Wiley, Respiratory Therapy

NICU Parent Advisory C ilKarla Wiley, Respiratory Therapy

Ozzie Rivera, Biomedical EngineeringJeff Hooper, Biomedical EngineeringMaire Soosar, ID/EpidemiologyLeland Kuhn, Materials Management

Council


Multi-bed Room Options


NICU with Private Rooms – Final Plan

• Help expand capacity• Improve throughput and work flow• “Lean” the NICU patient visit cycle• Control noise and enhance privacy• Provide family-centered carey• Convert to a “no-wait” NICU• Create CDUs and observation units


NICU Plan with Private Rooms

Private NICU Patient Room


Detailed Room Plan


Mock-Up Area


Old Entrance


New Entrance, Family Spaces


Decentralized Meds


Transition Planning


Schedule


NICU Transition Team Structure

Transition SteeringSteering

Committee

Clinical Operations Team

NICU Crew Team Facility Readiness Team

Communications Team


Transition Team

Tools T l

Transition Steering Committee NICU Clinical Operations Team

Tools Available

Tools Available Deliverables

Comprehensive Issues Log Issues Log Move Plan

Schedule• Gantt Chart• Milestone Log Schedule Operational

Plan

Go/No Go ListMove

Process M


Map

Transition Goals

• GOAL: Ensure a safe transition for all patients, families, and staff.• MEASURE: Zero adverse events or personal injury for family and staff.

• GOAL: Maintain continuity of care in a seamless process.• MEASURE: Number of reported care issues and total number patients moved.

• GOAL: Necessary equipment and supplies are available.MEASURE N b f li d i t i /t t l b ti t d• MEASURE: Number of supplies, manpower, and equipment issues/total number patients moved.

• GOAL: All staff trained based on individual roles and responsibilities.• MEASURE: Completion of staff training prior to move date with successful completed competencies.

• GOAL: All technology tested and functioning.• MEASURE: Number of technology issues/total number patients moved.

• GOAL: Staffing levels support patient care and transition requirements.MEASURE R t f i id t /i l t d t th l k f t ff il bl• MEASURE: Reports of any incidents/issues related to the lack of staff available.

• GOAL: Patient and family will be supported with information and education regarding the move process for their child.• MEASURE: Reports of patient/family complaints of not being involved in the move process/total number of patients

moved.


Existing NICU Day of Mock Move May 2009


Internal Move Route

• All NICU patients– Travel to transport elevator (held open by Security) directly outside NICU to

the 4th floor.– Move through the old Neuroscience Unit/Offices to the new East Inpatient

Tower by way of double doors (held open by Security.)T l b f l (h ld b S i ) h– Travel by way of new tower transport elevator (held open by Security) to the new NICU on the 6th floor.

– Upon arrival, NICU staff will be at the Greeter station to assist in moving the patient to his assigned room A stationed NICU UCA will “check” the patientpatient to his assigned room. A stationed NICU UCA will check the patient in, verify room number, and then the patient will travel to their pre-assigned room.


Return Route

• Move Team will stay together and return to the unit as a team with the necessary equipment for the next patient– Intubation Box/Code Meds– Battery Pack– Transport Monitor– Isolette, if applicable

• Moving Team will enter the designated “return” elevator in the 4 elevator bank area (held open by security) and travel to the 5th floor East

• Team will exit elevator and travel through double doors to 4th floor Main returning to the transport elevators in the Main hospital

• Elevator will be held open by security (from prior patient exiting) and taken to 3rd floor main to return to the current unit to begin next patient movefloor main to return to the current unit to begin next patient move.


The Ribbon Cutting


Post-Move Trends

• Quality Indicators• Family Satisfaction• Staff Satisfaction• Average Daily Census


GetWellNetwork© Feedback

• “All of the staff here at Children's have been so compassionate, throughout the 6 months my grandson has been hospitalized. We would like to especially THANK M & D b th b h t f f il Y h d th lMegan & Dawn; you both became such a part of our family. You had a motherly bond with my grandson when my daughter wasn't able to visit with her son. Thanks again Children's for all that you do to make the families a part of their child's hospital stay WE LOVE the new NICU feels like home ”child s hospital stay. WE LOVE the new NICU, feels like home.

• “My husband and I are so relieved that our daughter was transported to the NICU at Children's National Medical Center Everyone was very kind and friendly at aat Children s National Medical Center. Everyone was very kind and friendly at a time when we were extremely nervous and uncertain. Our daughter received superior care from all of her nurses (Monica, Kizzie, Denise, Victoria, and Debra). We felt right at home in this beautiful new facility We were also relieved to haveWe felt right at home in this beautiful new facility. We were also relieved to have a place to stay at the Washington Medical Center. It allowed us to stay close to our daughter. Thanks so much to everyone who supported us through a rough few days.”


Post Occupancy Evaluation

The impending move-in date of May 17th constrained our ability to conduct a pre-move assessment using newly developed and

lid t d t l Th f th t t i t f

PRE-MOVE GENERAL ASSESSMENT

The post-move strategy is the largest part of this study.

POST-MOVE GENERAL ASSESSMENT

validated tools. Therefore, the pre-move strategy consists of gathering information on measures that are currently collected on the unit and will be collected in the future.

There are 3 categories of pre-move collection information:1.Clinical Outcomes

yThe strategy for post-move, ‘transition over time’ evaluation, is to continue with the pre-move categories and add a survey that investigates how well the guiding principles were actualized in the new space.

– LOS– Weight Gain– Infections– Other currently collected clinical measures

2 S ti f ti2.Satisfaction– Family– Physicians and Staff

3.Built Environment – Noise– Lighting– In-unit flexibility– Walking distance

These measures will be evaluated using tools that the CNMC NICU has already utilized to analyze clinical outcomes


NICU has already utilized to analyze clinical outcomes, satisfaction, and the NICU environment.

Thank You!Thank You!


NACHRI%20Fall%202009%20A%20Carefully%20Calibrated%20NICU%2

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