Nurses in the NICU at Englewood (N.J.) Hospital and Medical Center have implemented a cue-based feeding program that has resulted in improved care and increased patient satisfaction. Staff is looking at whether it has decreased patients’ lengths of stay.
“Not only have we incorporated a program that provides better care, families are more involved in the decision-making,” said Mary L. De Ritter, RN, MSN, CNL, care manager of the NICU.
Using the Ludwig feeding readiness scales designed by Susan Ludwig, OTR/L, which focus on feeding readiness and quality of nippling, RNs look for indicators, such as hand-to-mouth sucking, visual states of alertness and signs of hunger (rooting). They also assess for technique, such as the infant’s decreased loss of liquid while feeding and the infant’s decreased need for chin and cheek support.
Depending on the scoring results, determined at least every three to four hours and during feedings, nurses choose the route of feeding, whether it be by oral or nasal/oral gastric tube. An infant might be fed orally at one feeding, and then by NG tube at the next, depending on the assessment findings before each feeding. If parents are present prior to a feeding, they make an independent readiness assessment, and discuss what they have observed with the nurse.
3-year processVictoria Kim, RN, care manager, OR, second from left; Ellen Ryan, RN, nurse educator; Nicole Chvasta, RN, cardiopulomonary care manager; Elizabeth Casagrande, RN, labor and delivery care manager; and Madelyn M. Pearson, RN, senior vice president, patient care services and CNO, speak with Eileen P. Williamson, RN, left, senior vice president, Nursing Communications and Initiatives at Nurse.com.
In guiding their study, Ritter and NICU staff considered the question of family involvement/satisfaction; lack of standardized practice related to feeding; and discharge delays related to the caregivers inability to feed their infants. After developing separate learning modules, De Ritter spent the first year educating nursing staff, physicians and families.
This past year, De Ritter and staff implemented the program, and they now are looking at patient outcomes. Press Ganey scores have improved, and it has been a team effort, with the involvement of Zahava Cohen, RNC, BSN, patient care director, staff nurses and the clinical nurse specialist, as well as the child life specialist, speech therapist and neonatologist. “We have taken the randomness and tradition out of the route of feedings, and through the assessment tools, we have standardized our care,” De Ritter said.
De Ritter and staff have presented their program and findings at national conferences through the Academy of Neonatal Nursing and the Organization of Nurse Executives.