Level III NICU at Memorial Hermann Southwest
The neonatal intensive care unit (NICU) at Memorial Hermann Southwest Hospital is a Level III (tertiary) provider of newborn services. We have 40 beds and provide varying levels of care including intensive, intermediate, and isolation. We have access to consultants, surgeons and ancillary services that allow comprehensive treatment across the full range of neonatal problems.
All care is directed by neonatologists in house 24/7. Our NICU is equipped with the latest technology and prepared with the most modern treatment modalities to provide the highest level of care.
Monitoring Statistical Information
Our NICU has long realized the need to track not only general NICU data, but important patient diagnosis based data in order to monitor our patient outcomes so that we could ultimately alter our care practices to improve those outcomes. Fortunately, in the year 2000, our NICU became the first NICU in the Memorial Hermann system to become a member of the Vermont Oxford Network (VON).
Established in 1988, the Vermont Oxford Network maintains one of the world’s largest NICU Databases. The Vermont Oxford Network is a voluntary collaborative group of health professionals committed to improving the effectiveness and efficiency of medical care for newborn infants and their families through a coordinated program of research, education, and quality-improvement projects. This database includes information from over 700 Neonatal Intensive Care Units around the world including care and outcomes for high-risk infants. High risk usually refers to babies born at very low birth weights (VLBW defined as 401gms to 1500gms babies or less than one pound babies to babies who are just a little over 3lbs, respectively). This database provides unique, reliable and confidential data to participating units for use in quality management, process improvement, internal audit and peer review.
VON was exactly what we were looking for to meet our needs! As a result of becoming a member of this database we have identified the areas of ROP, IVH, CLD and LOS and have been able to implement changes in our care that have resulted in improved outcomes.
Developmental and Family Centered Care
Research has shown that each interaction premature infants have with their caregivers has an impact on their developing brain and can influence the course of their NICU stay. The NICU at Memorial Hermann Southwest has been dedicated to developing a true Developmental Care and Family Centered Care NICU.
We strive to address all areas of infant development in everything we do while keeping the family at the center of our care team. Our philosophy of care and our unit's culture is woven with the firm belief that every encounter we have with an infant and their family has an impact on his/her development and future outcome.
From the special design of our unit, with space for families, developmentally specialized equipment and quiet surroundings, to the way we perform care; our goals are to support each infant as they continue to grow and develop and each family as they learn to nurture and care for their special infant. Even our most fragile patients are bedded in incubators and bedded with supportive bedding chosen specifically for their individual needs.
However, unlike many units' developmental care programs, ours doesn't stop with just the unit's design or with use of special products. Since infants communicate non-verbally through the way they move, breathe and react to what is going on around them, all of our staff are specially trained in reading and interpreting these behaviors. This allows caregivers to constantly adjust their interactions with the infants based on what the infant's behaviors are telling them they can handle.
Some of our staff has special certification (NIDCAP®) to perform in-depth neurobehavioral assessments that use this unique non-verbal communication. These staff members are not only able to provide neurobehavioral assessments, but also provide daily support to other staff and to families to ensure continuity in the individualized care given to each infant.
Currently, fewer than 25 percent of NICUs in the United States have NIDCAP® certified staff available for assessments and/or developmental care program support. Because our unit realizes that families are the one constant in their infants' lives, we therefore support parents to be their infant's primary caregiver by remaining open to them 24/7.
We encourage them to be at their infant's bedside as often and for as long as they desire. We encourage them to hold their infant skin-to skin (Kangaroo Care) as soon as their infant is stable, and we encourage them to remain with their infant to provide support during any exam, care giving task or procedure.
To encourage their hands-on involvement they are provided with guidelines outlining each step of their infant's development to let them know not only what to expect from their infant but also what they can actively do to help their infant. They are also invited and encouraged to be a part of weekly interdisciplinary rounds to ensure that they feel involved and to give them the opportunity to address concerns with the many disciplines involved in their infant's care.
The unit has a NICU Navigator who assists parents with any needs they or their baby may have to prepare a smooth transition to home. The Navigator assists parents in finding a pediatrician in close proximity to home that meets their baby's special needs. She also coordinates these visits with the baby's insurance provider to ensure coverage.
When follow up is needed with specialists, such as surgeons, pulmonary, or gastroenterologists, the NICU Navigator arranges for the appointments and provides pertinent information to the specialists to ensure that they are aware of the baby's special needs. The Navigator provides in-depth teaching for families with babies who go home with special needs such as ostomy care, central line care, gastrostomy tubes and nasal tube feeding, and home oxygen therapy. She is also responsible for ensuring that babies who need assistance with the Early Childhood Intervention program are registered with that program.
Dedicated Breastfeeding Support
We have our own certified lactation consultant and over half of our staff has undergone specialized continuing education for breastfeeding. The NICU encourages, supports and educates parents on the benefits of providing breast milk for their infants. We work together to educate parents on the immunities and protection that human-milk provides for the preterm or near term infant. We explain how providing human milk will help decrease their infants stay in the hospital and most often, moms will start pumping to provide their infants with this special gift, which is something that only they can do.
Our breastfeeding rates are excellent, well over 90 percent of our mothers will provide human milk for their baby. This is a major accomplishment for our moms it gives them a sense of control, because they are also taking part in the care of their infants. We encourage all our mothers to do skin-skin holding to help with their baby's growth and development as well as give them practice with non-nutritive sucking well before it's time for them to begin oral feedings.
We provide a spacious Lactation Room that is equipped with state of the art electric pumps, privacy screens, a sink and a radio, so that our moms have a place where they can go and pump, as well as relax. We also have electric pumps readily available for moms that prefer to pump at their baby's bedside. All of our staff is highly educated in lactation so help is always available to our parents if they have any questions or concerns.
Innovative Respiratory Therapy
A premature infant on a ventilator is a common sight in most NICU's across the country. However, having to receive support by ventilator is stressful to the infant and can be damaging to the upper airway. The goal of our respiratory team is to support our infants in the least invasive manner and in a manner that supports them to an earlier discharge and hopefully fewer discharges on supplemental oxygen.
Bubble Continuous Positive Airway Pressure (BCPAP)
The NICU at Memorial Hermann Southwest is one of the only NICUs in Houston that uses Bubble Continuous Positive Airway Pressure (BCPAP). Through our healthcare team's research, persistence and desire to deliver quality care to our tiny patients and to their families, instituting BCPAP has created a better experience and outcome for our Very Low Birth Weight (VLBW) infants. This is evidenced by our lower Chronic Lung Disease (CLD) and Retinopathy of Prematurity (ROP) rates.
Additional benefits of using BCPAP are that it is less invasive for the baby and parents can also hold their babies sooner. Being able to hold their babies sooner coupled with the fact that their babies are going home sooner results in greater family satisfaction.
An additional benefit of an infant using BCPAP is that these babies tends to have fewer annoying equipment alarms, which leads to improved employee satisfaction. This fact is evidenced by the highest employee satisfaction for respiratory therapy in the system at 4.66. The financial advantages are that BCPAP requires fewer supplies to be used, and because babies do better on BCPAP they are discharged sooner, therefore, decreasing the overall length of stay for this population of babies.
Dedicated Discharge Planner
Discharge planning that begins at admission are essential in the NICU. Starting at admission, parents are educated about their babies' specific needs. Special focus is given to preterm infant development, and parents are taught how to best help their premature baby adapt to their environment. The unit has a NICU Navigator who assists parents with any needs they or their baby may have to prepare a smooth transition to home. The Navigator assists parents in finding a pediatrician in close proximity to home that meets their baby’s special needs. The Navigator also coordinates these visits with the baby’s insurance provider to ensure coverage. When follow up is needed with specialists, such as surgeons, pulmonary, or gastroenterologists, she arranges for the appointments and provides pertinent information to the specialists to ensure that they are aware of the baby’s special needs. The Navigator provides in-depth teaching for families with babies who go home with special needs such as ostomy care, central line care, gastrostomy tubes and nasal tube feeding, and home oxygen therapy. She is also responsible for ensuring that babies who need assistance with the Early Childhood Intervention program are registered with that program.
Thanks to special funding by our volunteers, parents are provided with a DVD "No Matter How Small," which covers preterm brain development and different techniques and suggestions for supporting their infant's optimal growth and development while in the NICU. Parents are encouraged to attend the unit’s weekly Interdisciplinary Rounds. Rounds includes various members of the care team, such as the infant’s physician, case manager, dietitian, infant development specialist, oral feeding specialist, social worker, pharmacist, nursing staff, Early Childhood Intervention Program staff, lactation consultant, and respiratory therapist. These weekly meetings allow the team to coordinate care and formulate a plan to expedite eventual discharge. Parental involvement in this planning enhances the family’s feelings of being an active part of their baby’s care team, and allows them the chance to ask questions from all members at the same time. The more that parents are involved at an early stage, the more prepared they are for discharge.