Introducing Nursing Informatics in the NICU
Summary
Technology is constantly advancing in our level 3B Neonatal Intensive Care Unit (NICU) at CHEO, however, the way we were providing information to parents on their stay in the NICU and teaching prior to discharge home was lagging far behind. We were still providing parents with paper pamphlets and handouts they would often lose track of while dealing with moving from birth hospital to CHEO. After a critically ill baby’s birth, parents are often in different physical locations and the information provided may not be accessible. This fellowship was an opportunity to revolutionize this process and bring informatics into the NICU when it comes to providing information and teaching for families.
The fellowship was set to begin in March 2020, which was the same time the global Coronavirus pandemic really started affecting us in Canada. Administrators didn’t know at that time how the pandemic was going to affect us, but immediate measures were put into place at our hospital with visiting restrictions allowing only one caregiver at the bedside. Even those with mild symptoms such as a headache were not allowed to visit. The barrier to physical presence highlighted the critical nature of creating digital and virtual access to the NICU.
The fellowship began with researching digital resources available at other centres. I then conducted a survey of families in our unit to see what information they would like to know when they arrive at CHEO and where they currently seek information. Next, I began talks with directors in Information Services and eHealth who were looking into purchasing new technology. Our hospital’s electronic medical record is run by Epic systems. I attended virtual meetings with our directors and a representative from Epic to evaluate the purchase of one of Epic’s bedside applications. Their app would integrate the electronic chart and allow caregivers to access more features than I could have provided independently with an app developer. It was decided this may still be in future plans which steered my project in the direction of website content.
Overall learning goal
The overall learning goal was to increase my knowledge of nursing informatics and its application in a functional manner in the NICU. While the planned conference was canceled due to the pandemic, I did complete a literature review and benchmarked digital resources for parents that are available in other centres. I learned there are many more applications for informatics that we could be taking advantage of in the NICU.
Our unit was granted funding to purchase tablets for each bedside. It worked as a perfect fit for me to help introduce the standard work policy and implement this change in our unit. I collaborated with our leadership and quality improvement teams in choosing hardware that would meet all our functional needs. We have been able to go live with this change and have had parents who cannot be physically present in the unit meeting virtually with their baby and their health care team.
Parents in our unit are of an increasingly digital era and are accustomed to accessing information from a mobile source. The creation of original website content posed an informatics challenge for our development team. We had to learn to work remotely due to national physical distancing guidelines and mandated stay-at-home orders. I quickly became proficient with setting up online meetings and sharing documents on the cloud for virtual collaboration.
While many were interested in contributing to this project, no others at the hospital had received funding or time for implementation. Past projects I have contributed to have been managed by other leaders, however, I noticed a significant shift as I was the sole project manager on this. I learned to develop a timeline and to constantly have my sights set on the next steps and to plan my course of action. There was the extra challenge of being physically removed from the work environment. In normal times one might run into a colleague in the hallway or before a meeting and be able to brief them or ask a question. With today’s work environment, every interaction has to be planned and coordinated. The leadership and project management skills I developed will be valuable on any future endeavours.
Outcomes
The NICU at CHEO is currently undergoing a massive turnover in staff with an expected 42% of our staff to retire in a 5-year period. We have enjoyed decades of knowledge and experience to train new staff members and provide families with all of the teaching and information they need to safely bring their baby home. However, teaching information for families becomes more inconsistent with a massive influx of newly hired nurses. This digital resource will provide our staff with some consistency in messaging as there are many useful hints for new nurses who are taking care of babies as well.
I collaborated with Media House to take photos in our unit as a visual cue on the website. Before the shoot I created a storyboard and script for the video. We recruited a family, a nurse and a volunteer to star in the video outlining the basic information parents need to know when their baby is brought to CHEO. These photos and videos are now available on the external CHEO website for families to access from anywhere in the region. We can update the content as needed and families won’t have to keep track of the paper pamphlets we’ve historically provided.
CHEO’s strategic directions target connected care with the goal of faster access. Informatics in the NICU is advancing the way we deliver care so that families can access services when, where and how they need them. This also delivers on CHEO’s goal of wise resourcing as we will no longer need to print and store outdated pamphlets. As a sustainability plan, we can update the content online when policies change. We have planned to review content for changes at our Family Centred Care Committee meetings on a semiannual basis. If the hospital does decide to purchase a mobile application for caregivers in the future they can use the content that has already been reviewed and placed on the website and transfer it to the mobile platform.
Overall experience
Overall I found this fellowship particularly challenging as I needed to adjust to working remotely. It was a project that required collaboration from many parties and it was hard to stay on the top of everyone’s radar with so many competing demands while interacting virtually. All discussions had to be carefully coordinated. I learned a lot about technology resources in healthcare and the changing ways that parents acquire and consume information. Parents of babies in our unit have now grown up with technology and in some cases spend their days on their phone. It was important to provide them information where they seek it and to make sure that information is relevant. Parents are used to short, fun videos on social media platforms which we kept in mind when creating video content.
The photo and video shoot days were a highlight as they provided the families and staff involved with a positive memory of our unit. I enjoyed assembling the website content for parents as it is a good refresher of all the teaching we provide to them. The website will be available for all parents and staff and I will be presenting it to CHEO’s Nursing Advisory Committee at their upcoming meeting.
Technology and demands are always evolving and we have to be dynamic in response. The content that was developed for the website today may be carried over to a mobile application in the future when one becomes available. I’m proud to have played a part in developing technology that will positively influence the way we interact with families both in the unit and remotely by offering connected care. I am grateful for the opportunity this fellowship has provided in allowing me to create this website content that will serve as a valuable resource to parents, staff and those in our community and beyond.
