Mother Baby

Acuity Model
2020
Betty H. Cameron W&C Hospital @
New Hanover Regional Medical Center

Wilmington, NC
 Setting /
Culture:

• 45 bed level III NICU with ~ 56 NICU

admissions/month

• 35 room / 70 bed MB unit with ~ 300 newborn

admissions/month

§ 6 beds are Newborn-Extended Stay (NEST)

§ Newborn Observation Unit with 4 warmers
§ ~30% symptomatic or at risk for hypoglycemia
Newborn
Observation
Unit (NOU)
• Staffed by Newborn Nursery RN
and Charge RN

• Care provided for:

§ Hypothermic infants
§ Car Seat Tests
§ Circumcisions
§ Echocardiograms
§ X-rays
§ Venous blood draws
§ PIV starts
§ Babies needing close observation
and extra monitoring /
interventions to include oxygen
support via NC
 • Care provided for couplets including:

§ Infants requiring phototherapy

§ PIVs with D10W
§ IV antibiotics
Mom Baby Unit § 35 weeks and above for infants
meeting a minimum weight
requirement
§ DSS foster care / Adoption
cases
§ Infants that qualify for NEST
 Newborn
Extended Stay
Unit (NEST)
• Infants needing additional
monitoring with an extended
stay
§ NAS (with or without
pharmacological treatment)
§ NG feeds
§ Continuous cardiac
monitoring
• Rooms include:
– Centralized monitoring system
– MamaRoo swing in each room
 Background
Tool designed in March 2018
Often caring for higher
with opening of the Nest Unit
acuity infants in 4 couplet
to ensure adequate staffing
assignments
to care for NAS babies
Acuity
Tool
Revised tool to
account for all higher
acuity infants
 Acuity Reference
Lower Acuity Mid Acuity High Acuity Special Care
Nursery/Extended Stay
§ >24 hr stable couplet § <24 hr stable couplet § <12 hr C/S couplet § IV Fluids/IVABX
§ >24 hr stable C/S § 12-24 hr C/S couplet § Glucose POCT § Phototherapy (Lights)
couplet § 24 hr testing or other § LPT § NG Feeds
§ Stable NICU Mom § Breastfeeding § NAS couplet/service § Cardiac
§ Breastfeeding well challenges § Phototherapy (Blanket) Monitoring/pulse
§ Adoption/Split Room § DSS/Domestic case oximetry
§ Stable/Emotional- § Mental health § Pharmacologic Tx for
Social Challenges management NAS
§ Interpreter § Post delivery
§ Isolation complications
§ Hypertension/Q4VS
 Phone PHONE
ROOM 632- 2/16/2020 7A - 7P DATE RN 765- AcuityAcuityAcuity SC CHARGE RN - 6968
301 1351 ABRAHAM MCELROY PP 14-Feb NURSE 1 X
302 1352 BROWN NEILSEN C/S 14-Feb X
303 1353 COLLIN LOFGREN PP 15-Feb X DEL 0847 / GDM BABY BS
304 1354

Assignment Sheet
305 1355
306 1356
307 1357
308 1358 DAVIS LOFGREN PP 15-Feb NURSE 2 X DEL 2110
309 1359
310 1360 ELLIS GARNER PP 15-Feb X X DEL 1036 / 36+2 / IV FLDS
311 1361 FARNELL PARSLEY C/S 14-Feb X BABY ONLY
312 1362 GARRIS GARNER C/S 13-Feb NURSE 3 X
313 1363 HENDERSON LOFGREN C/S 16-Feb X X DEL 1830 / IV FLDS
314 1364 JOHNSON MCELROY PP 14-Feb X
315 1365
316 1366 KINDLE NEILSEN PP 15-Feb NURSE 4 X HTN
317 1367 LAMB PARKER C/S 16-Feb X DEL 0830 / SGA BABY BS
318 1368
319 1369 MANNING GARNER PP 15-Feb X DEL 1825
320 1370 NOBLE PARKER PP 15-Feb NURSE 5 X DEL 1605
321 1371
322 1372
323 1373
324 1374 OLAF NEILSEN PP 13-Feb X X BABY ONLY / NAS (MONITOR)
325 1375 POPPY PARKER PP 14-Feb X NAS
326 1376
327 1377
328 1378
329 1379
330 1380 QUAIL LOFGREN C/S 16-Feb NURSE 6 X X DEL 0648 / 36+2 / IV FLDS
331 1381 RUST PARKER PP 15-Feb X
332 1382
333 1383 SMITH GARNER C/S 14-Feb X HTN / NICU MOM ONLY
334 1384
335 1385
NOU 4830
NOU 4830
1ST FLOOR PASSES / VOLUNTEERS 7362 / 7369 WITHIN 24 HOURS
INTERPRETER 341-9052 PHOTO-3842 MOMS 16
PHARMACY 6477 / 7326 BABIES 17
BR BIRTH REGISTRAR 7097 NAS 2
LAC LACTATION RN 3933 TOTAL 33
NOU NURSERY RN / CHARGE RN RN 6.0
HUC UNIT CLERK RATIO 2.75
ADMIT NA#1 NA#2
DISCHARGED 301-335 CNA II
 Glucose
checks /
No IV fluid

• 1 Vaginal Delivery couplet

• 1 C-section couplet > 24 hours
• 1 Vaginal Delivery couplet At-risk and on Glucose checks
 IV Fluids

• 1 Vaginal Delivery couplet

• 1 Couplet – LPT baby on IVF
• 1 Baby only (Mom D/C’d)
IV Fluids

• C-section couplet > 24 hours

• C-section couplet < 12 hours with infant on
D10W
• Vaginal delivery couplet > 24 hours
 Hypoglycemia Data
• An average of 30% of our infants on M/B have glucose checks
because they either meet at-risk criteria or are symptomatic
for hypoglycemia
• We transfer an average of 2.6% of infants to NICU for
hypoglycemia
• An average of 16.6% of infants require IV fluids and remain on
M/B
• Our average weaning time for IV fluids on M/B is 23.4 hours
 Benefits of Rooming In
• Increased opportunity for skin-to-skin
• Increased opportunity for on-demand breastfeeds
• Regulated vital signs and glucose level in infant
• Decreased stress for mother and baby
• Increased maternal confidence in caring for infant
• Increased mother/baby bonding
 Hypoglycemia – Summing
up

• Evidence-based research shows that

both mom and baby benefit physically
and emotionally by staying together
• We have updated our acuity tool to
more accurately assign the higher
acuity baby (to include newborn
hypoglycemia) in the mother/baby
couplet care model
• The balance of acuity-based
assignments vs. productivity is still a
work in progress