“Did you know that just holding your premature baby against your bare chest for 30 to 60 minutes a day can help your baby be discharged earlier from the Neonatal Intensive Care Unit (NICU)?” says Teh Wan Ying, SGH Senior Physiotherapist.
Explains Dr Bharadwaj Srabani, Senior Consultant, SGH Neonatal & Developmental Medicine, “This skin-to-skin bonding is called Kangaroo Care, where the baby wearing just a diaper is placed upright on the father’s bare chest or mother’s bare breasts with a cover wrapped around both for warmth. This wrapping looks very much like a mother kangaroo holding her joey in her pouch – hence the name Kangaroo Care. A premature baby is underdeveloped and low weight - making him extremely vulnerable. Such skin-to-skin bonding helps the premature baby achieve a stable heart rate, breathing pattern and oxygen level, and thus the baby feeds better and reaches normal birth weight faster, amongst other benefits.” This Quality Improvement project Huddle to Kuddle is led by Physiotherapist Wan Ying, and supported by Nurse Clinician Audrey Seet, Dr Srabani and a multi-disciplinary team. Said Wan Ying, “When parents are not involved in the care of their premature baby during their baby’s early days, this can affect the development of the baby’s brain. The baby may have problems with reading, memory and attention in the future. Hence, globally, doctors try to get parents to care for their premature baby as soon as the baby is in the NICU.”
Aiming to improve the development of the premature baby’s brain, Wan Ying’s team encouraged parents of 23 premature babies in NICU to do Kangaroo Care early, while the baby is in intensive care.
The results were astounding including all 23 premature babies being discharged about 4 days earlier from NICU, improved feeding and showing improvement on motor development, for example, moving their neck and limbs. Their project won the 2021 SGH QI Project of the Year.
The team faced many substantial challenges throughout but managed to overcome.
Getting buy-in from fellow colleagues
“The biggest challenge was convincing our colleagues to do Kangaroo Care,” Audrey recalls.
“As the baby was attached to multiple monitors and intravenous tubes, our doctors and nurses were not comfortable touching the baby unnecessarily as they were afraid that the baby may catch an infection. Also, they had no guidelines to follow as Kangaroo Care in the NICU is not yet widely practiced in Singapore.”
“We implemented Kangaroo Care slowly. When our colleagues saw the positive outcome, we started to get buy-in.”
Dr Srabani adds, “Whenever our colleagues raised concerns, especially patient safety issues, Wan Ying and Audrey promptly got relevant experts to address their concerns.”
Helping parents gain confidence
“As premature babies seemed so small and fragile, the first Kangaroo care was always the most challenging because the parents were not confident in holding the baby, especially when the baby was attached to a breathing tube, and would feel uncomfortable once we placed the baby on them. And when the baby started to cry, the parents would panic because they did not know what to do to soothe the baby,” explains Audrey.
Wan Ying adds, “I found that spending 10 to 15 minutes educating the parents prior to starting Kangaroo Care helped build their confidence. Getting parents to be mentally prepared before Kangaroo Care was very important. This allowed the parents to visualize the entire process before doing it and made them less nervous.”
Working together as a multi-disciplinary team “We did not have a hierarchy in the project team,” shares Dr Srabani. “We voiced our thoughts and suggestions, and we also didn’t regard one another as separate disciplines but as one team working towards the same goal.”
Finding time for the project
In order to help parents gain confidence in carrying out their first Kangaroo care, the team spent more time educating the parents on the process. “Often I stayed back at work as some parents could only come after work,” shared Wan Ying, “I had to work during my own time to complete the administrative part of the project after my daily clinical duties.”
What keeps the team going?
“The smile on the mother’s face when she held her baby for the first time was priceless,” says Audrey. “This proved to us that Kangaroo Care was in the best interest of our patients. Then we were motivated to carry on no matter what.”
Recalls Wan Ying, “When I first started this project, the effort was deemed as ‘disturbing the baby’. But I was confident of implementing Kangaroo Care because I knew that I had supportive team mates - people who wanted a change.”
Quality Improvement is important in healthcare
Wan Ying and Dr Srabani concurred that as healthcare is ever-changing, we cannot stay stagnant. “In order to ensure the best outcome for our patients, we have to continue improving,” added Dr Srabani. “It may take a while to see results. Our Huddle to Kuddle QI project was conducted over nearly 1 ½ years. As a result of this project, privacy screens are now available in the NICU, creating an environment that provides parents with more privacy. We have also crocheted baby octopuses for the babies to grasp – this helps relieve their stress. If you believe that what you are doing is for the best of the patient, just persevere; don’t be disheartened.”
To staff who want to embark on QI
“Winston Churchill said, ‘To improve is to change, to be perfect is to change often.’ When we do QI, we have to add some joy to it, to find joy in what we are doing,” Wan Ying shares. “Celebrate small wins, and don’t be afraid to try new things.”
Added Audrey, “Challenges are always there to force us to improve and overcome them. Don’t be afraid of them, and don’t be afraid of speaking up.”
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