1. NICU Communication Improvement University of San Francisco Mater of Science of Nursing Clinical Nurse Leader Joy Lawley “The single biggest problem in communication is the illusion that it has taken place” George Bernard Shaw

2. Background & Microsystem Setting ▪ 366 beds non- profit acute care hospital ▪ JCAHO accredited and meets standards for staffing ratios ▪ Largest hospital in Stockton, California ▪ Specializing in cardiovascular care, comprehensive cancer services, and women and children’s services, including neonatal intensive care ▪ Twenty –two bed level III community Neonatal Intensive Care Unit (NICU) ▪ Providing all levels of care from critical to step down with the exception of neonatal surgery ▪ Problems with ineffective communication was identified through microsystems analysis, staff and the leadership team.

3. Specific Aim ▪ We aim to improve communication to the NICU through standardize communication tools (SBAR) from patient delivery to discharge starting April 1, 2015. With 100% participation of all staff members within a three month period and a 95% staff satisfaction related to improved communication from staff survey and reduction of missing information from chart audits by June 1, 2015

4. Evidence of Microsystem Problem

5. 2014 Avatar scores hospital consumer assessment of healthcare providers and system (NICU)

6. Causes of ineffective or miscommunication between labor & delivery and within the NICU

7. Methods: Lewin’s Change Theory

8. Methods ▪ Staff nurses from all shifts in the neonatal intensive care unit and maternal child department participated in structured communication approach to address the current issue of ineffective communication ▪ Change process included providing evidence based information on structured communication and including staff input on the communication tools.

9. SWOT Analysis: Internal StrengthWeakness ▪ High staff turn over ▪ Drifting from current standard of practice ▪ Inconsistent communication among leadership team and staff members ▪ Low unit morale ▪ Skilled staff specializing in care and stabilization of neonates ▪ SBAR report used in unit ▪ New leadership team ▪ New NICU CNS

10. SWOT Analysis: External Opportunities ▪ Increasing amount of monthly deliveries/ potentially increasing need of NICU care ▪ OB physicians hospital of choice to delivery high risk patients for NICU services Threats ▪ OB physicians delivering increased number of high risk mothers, increasing NICU patient volume ▪ Staff turnover to other local community NICU’s

11. Steps for Implementation: Project Time Line Manager Approval Introduction & In-services of new SBAR tool during daily shift huddles Evaluation Of Intervention Development and review of SBAR tools for delivery RN & NICU admissions Evaluation of SBAR usage through random audits Admission audits for missing information Staff survey

12. Results New communication tools distributed to NICU staff Shift change huddle updates Maternal Child staff provided information in mandatory staff meeting Chart auditsDirect observation

13. Results Staff Input change to delivery RN SBAR Drifting Ongoing coaching

14. Outcomes Staff Survey Scheduled to start last week of May & finish June 1, 2015 Chart audits & direct observation of SBAR tools Completed according to timeline

15. Recommendations Additional PDSA improvement projects Use results of chart audits, direct observation & survey results Employ a full time Clinical Nurse Leader Continuation of this project & other projects needed in the microsystem

16. Acknowledgements Thank you to all of the NICU and maternal child staff members who helped bring this project to life. A special thank you to Sharyl Stanton for her continued support throughout this process