Increasing Skin-to-Skin in a Level IV NICU: A Quality Improvement Project

Purpose: To evaluate the effect of a bundled intervention on the number of skin-to-skin (“kangaroo care”) events occurring in a level IV NICU. Design: A quality improvement effort centering around the introduction of an intervention bundle intended to safely increase the rate of skin-to-skin holding. Rates of unplanned extubations were recorded as a balancing measure to estimate safety. Sample: All infants admitted to the NICU from December 2017 through September 2019 were included. The “preintervention” period was the 6 months prior to the initiation of the intervention bundle (December 2017–May 2018). Results: The absolute number of skin-to-skin holds increased from the preintervention phase (range 7–28 holds/month, median 11 holds/month) to the postintervention phase (range 16–100 holds/month, median 55 holds/month). The total unplanned extubations showed no significant change between the preintervention and postintervention periods.