The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study.

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy.

A systematic review of instruments for assessing parent satisfaction with family-centred care in neonatal intensive care units.

This systematic review synthesised and described instruments measuring parent satisfaction with the increasing standard practice of family-centred care (FCC) in neonatal intensive care units. We evaluated 11 studies published from January 2006 to March 2016: two studies validated a parent satisfaction questionnaire, and nine developed or modified previous questionnaires to use as outcome measures in their local settings. Most instruments were not tested on reliability and validity. CONCLUSION: Only two validated instruments included all six of the FCC principles and could assess parent satisfaction with FCC in neonatal intensive care units and be considered as outcome indicators for further research.

Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study.

Family Centered Care (FCC) in Neonatal Intensive Care Units (NICUs) included family involvement in the care process of newborns and infants. Staff perceptions of FCC may influence clinical practice and management strategies in NICUs, with an impact on quality and humanization of the care. The Family-Centred Care Questionnaire-Revised (FCCQ-R) was adapted for the NICU setting, therefore the FCCQ-R@it-NICU was developed and used for the present study in 32 Italian NICUs. We calculated internal consistency using Cronbach's alpha correlation between Current and Necessary dimensions of the scale using the Pearson correlation coefficient. Furthermore, we investigated which characteristics could influence staff perceptions of FCC in NICUs. 921 NICU professionals participated in the study. The FCCQ-R@it-NICU revealed good internal consistency (0.96) and good correlation between dimensions (p < 0.05). Statistical and significant differences in Current and Necessary dimensions were found and some demographic characteristics were found predictable on FCC practice. The FCCQ-R@it-NICU is a valid tool to investigate staff perceptions about FCC in NICU settings. Profession, education level and work experience seem to positively influence the perception of what is required for FCC practice within NICUs.

The current practice of family-centred care in Italian neonatal intensive care units: A multicentre descriptive study.

OBJECTIVES: To explore family-centred care practices in Italian neonatal intensive care units and describe areas for improvement. METHODS: A cross-sectional, multicentre, survey was conducted using the Italian language version of "Advancing family-centred new-born intensive care: a self-assessment inventory". The instrument is divided into 10 sections rating the status of family-centred care (1 = not at all, 5 = very well) and ranking the perceived priority for change/improvement (1 = low, 3 = high). A representative group of staff and parent for each unit were invited to complete the survey. Data was collected between January and June 2015. Correlations among unit characteristics and sections within the survey were explored. SETTINGS: All Italian neonatal intensive care units (n = 105) were invited. RESULTS: Forty-six (43.8%) units returned the survey. The "Leadership" section scored highest in status of family-centred care (mean = 3.45; SD 0.78) and scored highest in priority for change (mean = 2.44; SD 0.49). Section "Families as Advisors and Leaders" scored lowest both in status (mean = 1.66; SD 0.67) and in priority for change (mean = 2.09; SD 0.59). The number of discharged infants was positively correlated with many sections in priority for change (r 0.402-0.421; p < .01). CONCLUSION: This study showed a variability in the organisation of family-centred care practices in Italian neonatal intensive care units and the need to involve parents as partners in the care team. Although family-centred care is considered important by Italian neonatology healthcare professionals, much remains to be done to improve family-centred care practices in neonatal intensive care units in Italy.

Neonatal intensive care parent satisfaction: a multicenter study translating and validating the Italian EMPATHIC-N questionnaire.

BACKGROUND: In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care. The aim of this study was to translate and validate the EMPATHIC-N instrument into Italian language measuring parent satisfaction. METHODS: A psychometric study was conducted in nine Italian NICUs. The hospitals were allocated across Italy: four in the North, four in Central region, one in the South. Parents whose infants were discharged from the Units were enrolled. Parents whose infants died were excluded. RESULTS: Back-forward translation was conducted. Twelve parents reviewed the instrument to assess the cultural adaptation; none of the items fell below the cut-off of 80% agreement. A total of 186 parents of infants who were discharged from nine NICUs were invited to participate and 162 parents responded and returned the questionnaire (87%). The mean scores of the individual items varied between 4.3 and 5.9. Confirmatory factor analysis was performed and all factor loadings were statistically significant with the exception of item 'Our cultural background was taken into account'. The items related to overall satisfaction showed a higher trend with mean values of 5.8 and 5.9. The Cronbach's alpha's (at domain level 0.73-0.92) and corrected item-total scale correlations revealed high reliability estimates. CONCLUSIONS: The Italian EMPATHIC-N showed to be a valid and reliable instrument measuring parent satisfaction in NICUs from a family-centered care perspective. Indeed, it had good psychometric properties, validity, and reliability. Furthermore, this instrument is fundamental for further research and internationally benchmarking.

OC47 - NICUs and family-centred care, from the leadership to the design, the results of a survey in Italy (by FCC Italian NICU study group).

UNLABELLED: Theme: Leadership, management, nursing education. INTRODUCTION: Family-centered care (FCC) in NICUs is related to staff culture and the organization of the unit. AIM: To describe the organizational characteristics and services for families in Italian NICUs. METHODS: This survey involved 105 NICUs in Italy. The Italian version of the 'FCC in the NICUs: A Self-Assessment Inventory' developed by the Institute for FCC was sent to the nurse managers in January 2015. RESULTS: Forty-seven NICUs answered (49%). The means of the NICU characteristics are number of beds: 20; newborns discharged/year: 331, of which very low birth weight infant: 68; unit's rooms: 3.7). The total mean score of the 10 areas explored by questionnaire was 2.6 (on 5 points Likert scale) for the 'status' and of 2.3 (on 3 points scale) for priority for change. CONCLUSION: The results show an organizational lack, but also the consciousness of the need of change. Sharing new organizational strategies could be an important issue for the future.

Accreditation of birth centres: advantages for newborns.

UNLABELLED: Accreditation or certification of Health Care Providers is a crucial tool to improve health care quality, and to promote excellence. Excellent healthcare should have the following six characteristics: Safe, Effective, Person-centred, Timely, Efficient, Equitable. Safety in health care should consider the analysis and reduction of medical systematic errors and their related patients' harm. In 1999 the U.S. Institute of Medicine defined medical errors as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. In neonatal intensive care units and pediatric intensive care units the areas most frequently associated with medical errors are medication, including prescribing, preparation, administration and monitoring; health-care associated infections; mechanical ventilation; events related to the use of medical devices or procedures and, more recently, caregivers fatigue and communication strategies. In Italy, Maternal-Neonatal Health is one of the national priorities, but there are still wide and deep differences among Regions. In 2008, more than 9% of the deliveries occurred in Hospitals with less than 500 births per year, a volume considered too small to guarantee optimal standard of care. In 2010, the National Government and the Regional Health Authorities agreed to set to 1000 births/year the standard threshold for Hospital Birth Centers, considering the same volume for obstetric-gynecologic and neonatal-pediatrics Units. Despite most indicators attest the good performance of the National health care, a further area to be addressed is the perception of its quality by the people. The discrepancy between quality of care and its public perception is in fact reported in many industrialized countries. Accreditation programs can improve the availability and access to a standardized quality of care. A well-established worldwide accreditation program is led by Joint Commission International (JCI). As far as accreditation of perinatal care is regarded, in 2010 the U.S. Joint Commission has defined a set of measures known as the perinatal care core measure set, which consider elective delivery, cesarean section, antenatal steroids, healthcare-associated bloodstream infections in newborns, exclusive breastmilk feeding. In Italy, the 2011-2013 National Health Care Plan underline the need for developing and implementing certification programs for Hospital Birth Centers. In 2011, a multidisciplinary working group (Italian Group for Safe Birth) has thus been established. CONCLUSION: the main goal of each Health Care Organization should be to achieve the best quality and safety. Health Care Organizations must reduce random variations and improve activities by a standardized process whose results can be measured both in terms of patients outcome and in terms of transparency of each activity. Newborn and infants are one of the weakest population group; to improve their health outcome is thus mandatory to do all efforts to obtain a safe, effective, efficient and patient-centered health care assistance.