The 15th of September marked National Neonatal Nurses Appreciation Day. There is one NICU facility here in Hernando County, part of Bayfront Health Spring Hill Hospital. Bayfront’s NICU boasts seventeen neonatal nurses. I sat down with three nursing staff leaders of Bayfront’s Neonatal Intensive Care Unit to talk about the facility and the services they provide: Stacy Andries, Interim Director of Women’s Services, Teresa Cancel, Women’s Center Educator and Rachel Provau, Chief Nursing Officer.
Bayfront’s NICU is a level 2 NICU which provides infants with necessary medical care such as IV therapy, medications and respiratory support. The level 2 NICU also provides closer monitoring of infants with special medical needs. (The level 3 NICU typically serves infants that require continuous respiratory support while the level 4 NICU provides surgical intervention.)
For infants that do need a higher level NICU, Bayfront has a strong alliance with John Hopkins All Children’s Hospital in St. Petersburg. Chief Nursing Officer, Rachel Provau, explained that Bayfront utilizes their physician staff and if they have patients who need that level of care, they are quickly triaged and a team accompanies the patient to Johns Hopkins All Children’s Hospital. A transport team from All Children’s comes to the Bayfront Spring Hill facility to provide the specialized care needed during the transport.
The Women’s Services area, labor and delivery suites and NICU are situated adjacent to each other within the hospital. “If we have any patient whatsoever that have any high risk symptoms, we have a NICU nurse in attendance. If we have a c-section patient, whether it is planned or not planned, we have NICU nurses available and respiratory therapists in attendance during delivery so that stabilization starts right at the moment of birth,” explained Provau.
“We have two amazing neonatologists who are so dedicated and helpful to the staff and very supportive,” said Stacy Andries.
The length of time an infant stays in the NICU varies, but an average stay is 5 to 7 days said Andries. Andries also explained that while the baby is in the NICU, they really encourage breastfeeding if the baby is strong enough to do so, as well as skin to skin contact. They also have lactation consultants working with moms to help them get their milk started and facilitate mother baby bonding.
“We are really expanding our lactation program,” said Andries. They are working to have lactation consultants available 24/7 and currently offer free breastfeeding classes in the community. “We have quite a few nurses that are pursuing their lactation certification,” Andries added.
Cancel, Clinical Educator explained that there are two designated suites at the end of labor and delivery unit right next to the entrance to the NICU where parents can stay after mom is released, if they meet certain criteria.
Provau further explained that they strive to provide opportunity for parents to bond with their newborns who need certain interventions since evidence based practice indicates there is a disconnect with parents when the child has to be put in the NICU.
“Our focus here is to offer that (opportunity for bonding) as much as we can based on what interventions have to be done for the child in the intensive care unit,” said Provau.
Provau explained that the emergency department is also close by, so if an infant needs emergency care following discharge, they are able to see a neonatologist right away and if necessary transfer them to All Children’s.
Safety is a top priority at Bayfront Health and the group of nurses I spoke with had much to say about the efforts put forth into creating a “SAFE culture” at the hospital.
Provau.explained the “SAFE” acronym: S for Support the team; A for Ask a question; F for Focus on a task; E for Effective communication. She said this has been established from sources of evidence based literature. “Not only is it the practice in nursing, it is the practice throughout the whole hospital. We’ve found that if we stay attuned to those things, we prevent a lot of things that could happen.”
For the hospital, the importance of safety does not stop when the baby is discharged. Andries explained that before NICU babies go home, they must pass a car seat test. These infants are often not able to hold up their heads properly due to lack of muscle development which may cause airway problems when positioned upright in an infant car seat.
In order to assess whether or not infants are safely able to travel in a car seat, the infant’s vital signs are monitored for at least 90 minutes while sitting in a car seat. If at any given time they aren’t tolerating the test, they are taken out and given 24 hours to try the test again, explained Cancel. She also explained that even if home is 5 minutes away, the test lasts 90 minutes. If home is over 90 minutes away, the car seat test will last as long as the trip home.
There are options though if baby does not pass the car seat test, but is deemed healthy enough to discharge. One is a car seat in which baby can lie flat.
NICU babies are also more at risk for apneic spells in which baby stops breathing for 15-20 seconds while sleeping. Some infants go home with apnea monitors, explained Andries. An alarm goes off if it detects less than a certain number of breaths per minute. They want their parents to be prepared and educated should a situation arise at home. In this vein, the hospital is also working on creating a CPR training course available to parents of NICU infants.
Staff at Bayfront hospital are routinely drilled for safety in case of an infant abduction and have several security measures in place to ensure infant safety.
They also conduct drills of emergency responses to medical situations that involve all levels of staff including techs and unit secretaries, explained Cancel. The drills cover a variety of medical situations, from shoulder dystocia (when baby’s shoulder gets stuck during birth) to postpartum hemorrhage. They even have a simulator mom who delivers a baby as part of their skills lab, added Andries.
Medical staff is required to maintain competency in the neonatal resuscitation program or NRP. Andries explained that anesthesia and OB providers participate in this training program as well.
Cancel couldn’t say enough about the respiratory therapists who serve the hospital. “They are highly trained and a really wonderful asset to have,” said Cancel. She explained that they even attend the NRP classes which is very unique. Provau stated, “It takes a team to take care of a very sick infant.”
Part of the teamwork that is incorporated into care at the hospital are safety huddles. Provau explained that the safety huddles are a very structured 5 minutes of communicating information about the patients. She emphasized that the safety huddles and the techniques used during change of shift streamline communication increasing the patient’s safety.
NICU nurse Anna Lee at Bayfront Hospital was working in the unit when I took a tour of the facility. She said it is an extremely rewarding career. “Not only do you get to take care of the baby, you get to take care of the whole family,” said Lee.
“Sometimes babies will need to spend 5 or 6 weeks here. And so we get to know the families very well,” Cancel explained. “They bring the babies back when they grow bigger and that’s my favorite part. It’s a really special bond between the nurses and the babies.”
“The goal is to have families still celebrate the birth no matter what the issues were and then have them be able to care for the babies and take them home, ” she said.
Even though taking care of sick infants is tough emotionally, added Cancel, “We are a different breed. This is our specialty. This is what we like to do.”
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UPCOMING COMMUNITY EVENTS:
Pediatrics Open House
When: Sept. 29 4-7PM
Where: Medical Arts Bldg, Bayfront Health Spring Hill
Description: Lots of great health information will be available. Pediatrician Dr. Schramm will be hosting a storytime. NAMI and HCSO will also be there.
Preparing for Pregnancy
When: 10/20/16 at 7pm
Where: in the café at Bayfront Health Spring Hill.
Description: Dr. Christina Gomez DO, OB/GYN-My Gynecologist will discuss “Preparing your body for pregnancy” and Dr. Heather Schramm MD, PhD, Pediatrician-Bayfront Health Medical Group Pediatrics will discuss “How to prepare for your new baby – a pediatrician’s perspective”. Seating is limited, call 352-797-4645 for more information.
Bayfront Health Spring Hill is located at: 10461 Quality Dr, Spring Hill, FL 34609