Cabell Huntington Hospital’s new Neonatal Intensive Care Unit showcases not only a significant change in aesthetics and comfort, but an overall change in the way babies – and families – are cared for.
Inhabiting the fifth floor of the state-of-the-art, $85 million North Patient Tower, the NICU has modified everything from the types of flooring and ceiling tiles used to the way nurses communicate and the amenities for the tiniest of premature babies.
“The NICU has experienced the single single most dramatic practice change of any unit that’s moved into the North Patient Tower,” said Amy Smith, Women and Children’s Services director. “The medical director of the unit and our CEO, Mr. Marsteller, invested a lot of time and energy talking with other CEOs and hospital staffs to make sure this was where we wanted to go with the unit.”
Curb appeal
Since the NICU relocated, it has expanded to three times the size of the original unit and gained an additional seven beds. No expense was spared in outfitting the rooms with large windows for natural light and making better accommodations for new parents, who are now able to stay with their premature babies 24 hours a day by sleeping on daybeds in the rooms.
“We were able to allow parents to stay with the very critically ill babies before, but now all parents are more than welcome to stay – comfortably – and help care for their babies,” said Lori Blackburn, NICU nurse manager.
The unit has also added a special area called “Zaine’s Room,” equipped with a television, computer, kitchenette and shower facilities for parents who need to escape, if just for a few moments.
Thanks to the generosity of Paige Nelson, a Cabell Huntington Hospital employee who donated $10,000 to the unit, parents have access to some of the comforts of home. The room is named in memory of Nelson’s infant son who died of a rare congenital heart defect when he was two weeks old.
“When Zaine was sick, we had to take him to Cincinnati Children’s Hospital and they had a room like this,” Nelson said. “It was nice to get away from the monitors and hustle and bustle, even if it was just for a few minutes or to use the computer to pay bills.
“So many people from the hospital donated money to our family to help us with our expenses when Zaine was sick,” Nelson continued. “But we are so blessed and fortunate that we didn’t need it all, so we decided to give it to the new unit to help the families in some way. I knew how much I appreciated having a quiet place to escape to and we thought the parents here would appreciate that, too.”
Healthful changes
Most hospital NICUs still utilize a ward-type setting, with all NICU babies in one large room with multiple beds. For both the families’ comfort and because of new research into the advantages of moving from the ward setting, the hospital decided to move to all private or semi-private rooms (which are designed to accommodate twins and other multiple births).
“The research in the past couple of years has found that, developmentally, babies do much better in a quiet environment. They grow better, they get better quicker and they usually get to go home sooner without the constant monitors and alarms going off around them. Even the very youngest babies sense when noise is going on around them,” said Blackburn of the 700-plus NICU admissions each year. “The best thing for them and their families is to have a quieter, more private room where the moms can breastfeed and families can spend time together without sitting in the middle of the room with a bunch of other people.”
Cabell Huntington Hospital took it a step further – not only are rooms private for families, but they have been built with specially-designed flooring and ceiling tiles to soundproof the rooms as much as possible. Increased natural light has also been shown to be of great benefit to a premature infant fighting to put on weight and go home.
“The amount of detail the hospital went into to provide the best, family-centered care is amazing,” Blackburn said.
In addition to the new space, nurses are also having to get accustomed to a new monitoring system. Because each baby now has its own room, maintaining a good grasp of how each baby is doing could have been a challenge.
“We definitely have more space to cover, but the way we take care of our babies is the same,” Blackburn said. “It’s a big change, but it’s better for everyone all the way around.”
The new monitoring system sends an alert to each nurses’ cell phone, allowing instant updates that nurses can check right on their person.
“The nurses have been wonderful in adapting to the change in the way we communicate,” Blackburn offered.
Another change that has greatly improved care for premature babies at Cabell Huntington Hospital has been the use of CPAP machines instead of ventilators. Though the hospital has been using the system since late 2002, moving into the new unit combined with CPAP usage has elevated the hospital into a new level of patient care.
CPAP is a respiratory support system for babies born with either premature lung disease or respiratory distress syndrome. In the past, these babies would have required a ventilator, which brings with it a host of potential long-term side effects. CPAP is noninvasive – using only a small mask – to apply constant pressure to a preemie’s lungs. Babies as young as 26 weeks gestations have seen great results from the system – including decreased length of stay and quicker developmental adjustment. Out of 300 hospitals in the industry’s Vermont Oxford Database, Cabell Huntington Hospital consistently ranks as a leader in respiratory management of premature babies. In the first full year of CPAP usage, the incidences of chronic lung disease fell from 80 percent to today’s four to six percent.
“It may not sound like a big thing, but when you take home a baby with chronic lung disease, you’ve got several years of fighting infections and other problems, CPAP is a miracle,” said Sara Murray, the NICU’s clinical coordinator.
Murray fought to bring the CPAP units to the hospital, even flying to London to learn how to use the machines. Some staff members were still resistant to the idea when it first came to the hospital, but soon realized the benefits far outweigh any negatives.
“It is a lot more work for the nurses. You have to remember, ventilators are secured to the baby and babies are sedated a lot more. On CPAP, babies are not sedated and you really have to check the babies’ noses to make sure the masks aren’t too tight or too loose, that the babies haven’t accidentally pulled the unit out,” Murray explained.
The incidence of babies going home on oxygen has significantly reduced and babies on CPAP, once stable, can breastfeed. The long-term benefits – seeing very premature babies years later walking and talking with no lasting side effects – makes all the work worth it. In the short term, Murray said she is confident parents prefer the CPAP to older methods.
“One thing every mother wants is to hear her baby cry. When a baby is ventilated with a tube down its throat, mom doesn’t get to hear that,” she explained. “Parents also get to hold the babies sooner and can do kangaroo care without worrying about pulling the tube out.”
The overall mission of the NICU – from the new monitoring system to the private rooms to the success of the CPAP machines – is with one purpose in mind.
“We’re here to do a job and that’s to make sure babies go home to have a healthy and happy future that is bright for them, so they lead successful, productive lives,” Murray said.
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