The Evolution of an Interdisciplinary Developmental Round in a Surgical Neonatal Intensive Care Unit

Abstract

Background: Developmentally supportive environments are known to improve medical outcomes for hospitalized neonates and are considered the overarching philosophy for practice in the neonatal setting. Developmental rounds are a strategy incorporated by multidisciplinary teams to support development within and beyond the neonatal unit. Typically, they consist of bedside consultations and individualized developmentally supportive recommendations for families and clinicians. Globally, the use of developmental rounds has been described since the early 1990s. They are viewed as a measure to counter some of the barriers to developmental care implementation while buffering against the effect of an intensive care admission. To date, their use in the surgical neonatal intensive care unit (sNICU) has been minimally reported in literature. Purpose: This article describes the focus and work of a developmental round team and strategy in the sNICU. Method: A retrospective audit of developmental round key performance criteria undertaken over a 4-year period (2015-2018). Findings/Results: More than 300 developmental consults and 2000 individualized developmental recommendations occurred annually. Parental presence during the developmental round increased by 10%, from 48% to 58%, during the audit period. Implications for Practice/Implications for Research: Literature has supported the use of developmental round interventions; however, minimal data have been reported to date. This article provides retrospective audit data of a developmental round intervention in the sNICU with a focus on data over 4 years to highlight key areas, including the structure and process, recommended educational standards for team members, and parental engagement, as key markers for developmental round efficacy. Future research should focus on the link between the developmental round intervention and long-term neonatal outcomes.

Does the Implementation of Multidisciplinary Developmental Care Rounds Increase the Utilization of Developmental Caregiving Interventions in the Neonatal Unit?

“…All members of the team strongly believed that there needed to be a greater focus on the importance of FCDC interventions and their impact on short- and long- term health outcomes, including additional opportunities for parents and families to be involved in planning and caregiving at the cot-side. The implementation of a developmental care round was identified as an important strategy that would hopefully further embed FCDC practices through a multidisciplinary and formalized collaborative approach, an intervention successfully introduced into other critical care units both locally and internationally 27,28…”

“…Despite FCDC practice being recommended and incorporated into neonatal care more than 40 years ago, continued recognition of the benefits by the primary care clinician and the implementation of supportive care practices at the bedside remain a challenge in the neonatal unit. Several barriers to the integration of FCDC into clinical care have been identified in the literature, including parents not feeling confident as decision makers, insufficient nursing time, a lack of developmental care experts, and a lack of awareness by staff on the importance of developmental care practice and its correlation to neonatal outcomes 26–28…”

“…[26][27][28] Multidisciplinary developmental care rounds have been proposed as a strategy to not only aid in the early identification of high-risk infants but also provide a model of care that fosters an opportunity for teaching and a platform for bedside staff and parents to plan and contribute to care planning activities. 27,28 The implementation of developmental care rounds into both neonatal and pediatric intensive care units has demonstrated that regular weekly developmental rounds conducted by a team of expert multidisciplinary clinicians are effective in promoting developmental care practice. Several studies have shown that by promoting and reinforcing the fundamental principles of FCDC with families and primary care clinicians at the cotside, there is an increased awareness of the importance of FCDC on health outcomes, greater confidence and engagement with neuroprotective interventions, and a plan of care that is more individualized and responsive to the needs of the infant-family dyad.…”

“…Several studies have shown that by promoting and reinforcing the fundamental principles of FCDC with families and primary care clinicians at the cotside, there is an increased awareness of the importance of FCDC on health outcomes, greater confidence and engagement with neuroprotective interventions, and a plan of care that is more individualized and responsive to the needs of the infant-family dyad. [27][28][29]…”

“…Several barriers to the integration of FCDC into clinical care have been identified in the literature, including parents not feeling confident as decision makers, insufficient nursing time, a lack of developmental care experts, and a lack of awareness by staff on the importance of developmental care practice and its correlation to neonatal outcomes. [26][27][28] Multidisciplinary developmental care rounds have been proposed as a strategy to not only aid in the early identification of high-risk infants but also provide a model of care that fosters an opportunity for teaching and a platform for bedside staff and parents to plan and contribute to care planning activities. 27,28 The implementation of developmental care rounds into both neonatal and pediatric intensive care units has demonstrated that regular weekly developmental rounds conducted by a team of expert multidisciplinary clinicians are effective in promoting developmental care practice.…”