Low-stimulus ‘Family Single Rooms’

Improves care for newborns in UZ Gent, Belgium

Every newborn and their parents benefit from a space to be together with as few stimuli as possible. For example, alarms make up a large part of the noise level in the room. That is why it is a challenge for every hospital to work on a low-stimulus environment in the neonates and children’s wards. Especially at a time when the furnishing of a new building is planned.

Nele Nuytten, Project Manager Biomedical Technical Service, Karen Van Quekelberghe, Adjunct Nursing Neonatology, Isabelle Sasanguie, Midwife Neonatology and Dr. Kris De Coen, Deputy Clinical Head of Neonatology can share their thoughts on this. Together with itemedical, they and their project teams succeeded in creating a quieter environment at the new Neonatology intensive services at the University Hospital Ghent (UZ Ghent).

1. Family Centered Care

In Low-stimulus Neonatology for better care

More and more Neonatal services are applying the Family Centered Care concept: parents are closely involved in the developmental care for the newborn. They change their baby, take the temperature themselves, wash the baby, there is as much skin-to-skin contact as possible. Since the beginning of 2000, the Neonatal Service of UZ Ghent has also been using this concept. Congresses on developmental care, literature as well as the report of the Federal Knowledge Center for Healthcare: all highlight that striving for parental participation, combined with single family rooms, only benefits the growth and development of babies. That is why UZ Ghent opened a new care unit last summer with closed rooms according to the ‘silent room concept’ for mother and child. In this low-stimulus environment, parents can stay with their baby 24/7, it stimulates the growth of the newborn and significantly reduces stress.

The stay in a NICU is an intense period for the parents. With hardly any privacy, a lot of noise and alarms around their baby that they cannot interpret. The stressful environment in which the mother finds herself, among other things, ensures that breastfeeding starts slowly. If the parents are more present, the involvement in the care of their child grows. The more rest and fewer stimuli you create for them, the better breastfeeding will get going, so that parents and child can go home sooner. From a scientific point of view, this can only be substantiated with long-term trend data and results from larger groups. In addition, the healthcare professionals of 4B1 work with the analysis software of itemedical and they want to extend this to the other critical services of NICU in UZ Ghent.

Source: Scheiding tussen ouders en pasgeborene moet zoveel mogelijk beperkt worden | KCE (fgov.be)

2. Insight into alarm situation

The results of this analysis also provide insights for the move to the new building and the furnishing of the Single Family Rooms. Estimating the load of alarms in advance helps to draw up a responsible schedule for the most intensive patient population. How does this work for the parents, for care providers, the doctors and the nursing staff? They get a better idea of ​​what the new department should ideally look like.

In a low-stimulus environment, the project team mainly looks at the noise level in the room. Alarms are a big part of that. By intelligently sending signals from the monitors to the smartphones of the nurses, the medical device itself can remain as still as possible. Because some parents opt for more silence and the display is in privacy mode. Other parents want to follow the information on the screen and it only gives a minimal sound. In the evening, the monitors go into night mode anyway. This results in a considerably quieter environment.

The Medical Alarm System (MAS) then initiates the alarm cascade: itemedical’s software filters the warnings for clinical relevance and delays them where possible. The alarm distribution system (ADS) delivers the remaining emergency signals to the right care providers, creating a safe ‘silent room’ concept. The door of the room can be closed, the devices are as quiet as possible, the nurse receives the relevant signals. And the parents retain privacy in the room and thus enjoy the peace, together with their baby.

3. From ‘room concept’ to Single Family rooms

In low-stimulus Neonatology

The parents

The transition from the room concept in the NICU to the Single Family Rooms has a significant impact. In the large space, parents often feel superfluous and a visitor to their own child instead of a partner in care. On the other hand, they feel well surrounded, because there are more nurses around and they can compare them with other babies and parents. This creates a (partly false) sense of security. When they move to the Single Family Rooms, that protected feeling disappears. The familiarity of sounds disappears. They need confirmation that their baby is guarded as well. UZ Ghent therefore explains the alarm system in an information brochure. The healthcare professionals show them how the smartphones receive the alarms. The safety net is the same size as with the room concept, but it is not immediately visible.

The nurses

Developing a silent room trajectory for nurses is also not easy. Acceptance can be difficult. Karen van Quekelberghe and dr. The Coen explain this.

1. Karen Van Quekelberghe: “The nurses often experience the sounds around the bed as comfort. After all, each alarm has its own pitch, frequency and typical sound. If that is lost, that comfort often also disappears. On the other hand, you want them to keep their focus on the critical signals. That is why we opted for this system of quieter alarms and the associated process with alarm coaching. It is just as busy for the nurses at 4B1: they care for the same number of patients. But they go home with a calmer head because there is less noise and stimuli, because we filter the alarms better. The monitor is as still as possible, while the alerts are sent intelligently to the right person. That is a big profit. This reduces alarm fatigue for them.”

2. That is also one of the objectives that itemedical strives for with the alarm management model: less stimuli for parents and babies, but especially for nurses in order to combat alarm fatigue. Together with the department, we look at how you can differentiate the alarms in a smarter way. Dr. De Coen: “By understanding this data, you can analyze and interpret alarms. A combination of values ​​determines whether you filter alarms in advance or not. You can easily switch off less reliable signals or link them to a time limit: if a clinically less relevant alarm persists for x time, you should check this because there may be more going on. This way, you can keep your attention on clinically relevant alarms. You should also not lose sight of the legislation: you still have to keep a distinction between primary and non-primary alarms. We therefore forward high-priority alarms unchanged to the smartphones.” The introduction of a MAS is therefore a matter of focus: what is the essence of the entire alarm system and what is nice to know.

3. The allocation software, the room nodes, the smartphones, that is quite a technical part. Therefore, preferably a clinical person explains the new way of working to the nurses. This way you avoid mistakes, assumptions and fears to get started with this system. How does the delay work, who is the first to receive the call, who is the 2nd in line, what is the differentiation between the different alarms, … dr. De Coen: “If that matches what they themselves see in the data, they feel safe and familiar with the system. If they feel that a certain alarm is not going through, you follow the process in the analysis software. A yellow alarm delays e.g. by 10 sec., a red alarm immediately comes through on the smartphone. That is the process of teaching & learning.” Once implemented it is a continuous learning process, not only for new users but for everyone. You constantly adjust the process.” Karen: “Because I am involved as a nurse from the start, I also understand the technical aspect. But for someone who steps into this process later, the technical side is sometimes too complex. A nurse or a doctor then wants a more tailor-made explanation.”

Biomedical service & clinical support

The validation of the entire MAS was done by the Biomedical Service team. They have the necessary expertise for this. The monitor is at the heart of everything. If that changes, the alarm cascade should also fit into that change process.

Nele Nuytten: “When a system is technically completely ready, clinical support is also important. After all, fine-tuning the alert system depends on the right filtering and delay and we can’t do that ourselves. It’s a multi-disciplinary story: on the technical side, a comprehensive introduction to the system is important, and on the care side, interpretation by a clinical person is needed to make the alarms smarter. This is the only way to achieve good adaptation of the new system. Forwarding the alarms to smartphones must not be done rashly, because then your project will go wrong. Nurses often don’t think about that.”

Karen: “Equipment around the bed really generates a huge number of alarms. And you only notice that when they arrive on the smartphone, close to you. That’s why looking at the data in advance is so important. By understanding the number of alarms, alarm duration, types of alarms, you can apply better filtering and make choices. Which alarms do you forward to a nurse’s smartphone and when?” These choices should be made based on available evidence, checking what is justified and what is not. Adjusting limits too tightly so that you no longer get alarms creates an unsafe situation and should be avoided at all costs.

Advice: set up a multidisciplinary team

The UZ Ghent care team itself recommends involving a team of super users in the project from the start. They walk around on the work floor, they speak the same ‘language’ and therefore more easily support the other users. The responsibility for providing the training itself lies with the supplier of the ADS on the one hand, and the alarm coaching for interpreting the alarm data and the flow to the alarm system on the other hand.

4. Alarm reduction with safe back-up

With a MAS

UZ Ghent is working in several departments to reduce the number of alarms, but nowhere as far-reaching as in the Neonatal intensive care unit. For example, the PICU works with text messages and DECTs as an alarm system. However, because this is not set correctly, the dects are simply in the cabinet. All doors are open and the team sounds the alarms loudly on the medical devices so they can hear them. The alarm misses its target and is therefore a useless investment. Fortunately, technology has now moved on and the NICU is really committed to this: the telephones do not end up in the cupboard, but are part of a truly quieter department. Dr. De Coen: “And we could only do that by first looking at the data and only then filtering and delaying sending alarms, thus limiting the load on the smartphones to the clinically relevant alarms. Otherwise the project will fail in advance.”

But how do you ensure safety in this process? Because by sending the alarms via a platform to a smartphone, this becomes a very critical chain. Isabelle Sasanguie: “We developed an information book for the nurses about how the alarm system works. How do they register, how do they select the buddies. When the alarms only come to the central station and not to their smartphone, they know that something is wrong in the system. They get a “disconnected” message on their phone. The emergency numbers are listed in the information book in case of a breakdown during the week or at the weekend.”

In addition to the MAS system, UZ Ghent therefore consciously opted for a Medical Call System (MOS) system as a back-up. Nele Nuytten: “That is an important pillar for us: where possible, we strive for double alarms, especially for the red alerts. We connect everything with a MAS and a MOS system, the latter being a fall-back for the MAS. The red alarms therefore appear twice on the smartphone, but in that case we opt for certainty. The nurses are used to that by now. It is our main safety net. In addition, we also made a risk analysis for all fall-back scenarios: at what level can problems occur, what measures have we already foreseen as measures, what actions can we take. Combined with the user manual and the training we provide, we can rely on the system.”

5. Correct combination

of ADS and alarm differentiation

The choice for 25-8 as supplier of an ADS (Alarm Distribution System) and itemedical as alarm differentiation is obvious for UZ Ghent. UZ Ghent already uses the services of 25-8 for the distribution of nurse calls to smartphones. 2 systems next to each other would mean a double investment. Moreover, a nurse would have to walk around with 2 output devices, that does not work. Nele: “I also wanted to be able to work vendor-independently for my alarm system. Because it starts with monitoring, then syringe pumps, ventilators, … It must be a vendor-independent and flexible system, ready for future investments by the hospital. Furthermore, the differentiation in alarms was also important, the translation of the alarms, the delaying of them. 25-8 brought us into contact with itemedical. Together we then mapped out this trajectory.”

6. Practical experience after implementation

in low-stimulus neonatology

Isabelle: “We can now let the parents participate in the care and give them the necessary privacy to be alone with their family in their cocoon. And yet they feel surrounded by the best concerns with the safety of the alarm.”

Karen: “We also really experience a lot more peace with parents, they know their baby through and through, because they can stay with them 24/24. That used to be much less and the parents still went home quite insecure.”

Nele: “The care floor always comes up with many questions and wishes and we always try to meet them as much as possible. If they are satisfied with the solution provided, that gives us great satisfaction, especially if it actually works as they envision it. Also thinking about the final fine-tuning gives us great satisfaction. Because technically the solution is the same as for lung disease, but the need for smart alarms and alarm cascades is very different.”