Improving oral care for neonates in NICU
Yong-Chuan Chen is a head nurse at the neonatal intensive care unit (NICU) in Taichung Veterans General Hospital, Taichung, Taiwan. The hospital provides 18 beds for critical neonatal care (including premature infants) in the NICU, which caters for 12 to 15 critical neonates every day.
In the NICU, some newborns with acute and severe diseases rely on ventilators, so an endotracheal tube needs to be placed in the oral cavity; other newborns are treated with a nasal prong. Most infants are also fitted with oral/nasogastric tubes to sustain their life and provide them with nutrition. These invasive catheters can cause excessive oral secretions. If oral care is not performed correctly, health issues such as dry mouth and lip mucosa, excessive saliva and mucus, tongue coating, redness, pressure sores, vitiligo and thrush may occur.
With the mean incidence of neonatal oral problems in the NICU as high as 45.16%, Yong-Chuan Chen is dedicated to improving care for newborn babies: ‘We used the JBI implementation model to set up an oral care team and apply empirical translation to the quality improvement program’, Chen says. ‘JBI clinical guidelines suggest that if nurses can properly perform neonatal oral care, oral problems can be averted. This means that the incidence of intraoral infections and other complications can be decreased; the comfort of neonates can be improved; the length of stay in the intensive care unit can be reduced; hospital costs can be economised; the quality of hospital care can be improved; and future oral cavity development can be promoted.’
Chen formed an oral care team, based on JBI clinical guidelines and JBI PACES (Practical Application of Clinical Evidence System) evidence-based audit criteria. The team members included nurses, the supervisor of infection control, a neonatologist and a dentist. A baseline audit showed that only 20% of nurses performed neonatal oral care correctly. The audit also revealed that nursing personnel did not perform a complete oral assessment correctly, and that their oral care methods were inconsistent.
The team used JBI PACES and the Getting Research into Practice (GRiP) audit and feedback tool to help improve care quality of newborns in the NICU. In July 2020, the dental care team at the hospital provided in-service education in the NICU. Nurses were instructed on how to perform an oral cavity assessment and care on neonates. Video recordings of the training sessions were made readily available to staff for their reference. In addition, standards of procedure and direct observation of procedural skills (DOPS) for nursing technique were developed according to JBI clinical guidelines, and neonatologists were invited to review and modify them.
‘Educating nurses to help them realise the importance of neonatal oral care and empowering them by giving them the knowledge to work and collaborate with us to check the evidence base and establish the assessment and care standards, enabled us to develop specific and evidence-based care methods that had the buy-in from NICU staff. We are very happy to see the refreshing little mouth of each newborn.’
A follow-up audit found that after three months of implementing and promoting the improvement measures, approximately 90% of the nurses in the NICU could correctly assess the oral condition of a newborn. The rate at which the nurses performed newborn oral care correctly increased from 20% to more than 90%, and the mean incidence of oral problems decreased from 45.16% to 12.32%.
The improvements in neonatal oral care will be sustained by regular audits to identify if nursing staff are continuing to perform neonatal oral care correctly. Moreover, the team will develop exclusive neonatal ventilator-associated pneumonia care bundles, so that the future clinical inspection processes of neonatal oral care are more efficient to help improve quality of care for newborn babies.
Resources
JBI Manual for Evidence Implementation
Authors
Yong-Chuan Chen1, Chia-Hui Chang1, Pi-Hua Chang1, Mei-Yu Chang1
1 Taichung Veterans General Hospital, Taichung, Taiwan
Disclaimer
Republished with permission from World Evidence-based Healthcare Day https://worldebhcday.org/stories/story?ebhc_impact_story_id=38