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Implementing potentially better practices to support the neurodevelopment of infants in the NICU



The purpose of the Vermont Oxford Neonatal Quality Improvement Collaborative 2005 was to explore improvements related to the physical environment of the newborn intensive care unit (NICU) in order to optimize the neurodevelopmental outcome of newborns.

Study Design:

Five centers were involved in a focus group examining NICU environmental design and its impact on the neurodevelopmental outcome of the neonate. Using an evidence-based approach, the group identified 16 potentially better care practices. This article describes the implementation approaches for some of these practices. The practice areas include tactile stimulation, providing early exposure to mother's scent, minimizing exposure to noxious odors, developing a system for noise assessment of the NICU acoustic environment, minimizing ambient noise in the infants environment, and preservation of sleep.


Approaches to implementation were center specific. Optimizing neurodevelopment of the newborn was the desired goal, but this outcome is difficult to measure with a limited number of subjects over a short study period. Many of the changes although intuitively beneficial are difficult to measure. Education of all participants was considered essential to the process of implementation.


The process of collaborative quality improvement is useful in identifying ways to optimize the physical environment of the NICU to improve the neurodevelopmental outcome of the neonate.

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This report was completed as a part of the NIC/Q 2005 Collaborative to Improve Neonatal Care, which was sponsored by the Vermont Oxford Network. The Group thanks Stanley Graven, MD for clinical expertise, William Liu as the clinical leader and Jim Handyside for expert facilitation. We thank the representatives of the participating centers that contributed their efforts to the preparation of this paper: Benefis Healthcare: Beckett Perkins NNP, Vicki Birkeland RN, BSN, Rob Archer RT, Cheryl Worden RN; Mississippi Baptist Medical Center: Sanjosa Martin RN, Jack Owens MD, Jennifer Richardson NNP; Sunnybrook Health Science Center: Michael Dunn MD, Elizabeth MacMillan-York, Dorothy Dougherty RN; The Children's Hospital of Southwest Florida: Sandra Blackington RNC, MS, Sandra Eanes-McGugan RN, BSN, Marilyn Farley NNP; Wesley Medical Center: Susan Laudert MD, Paula Delmore RNC, MSN.

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Correspondence to W F Liu.


NICQ2005: Physical Environment Focus Group Senses and Sensibilities: Appendix 1. NICU Current Practice Survey: NICU Current Practice Assessment: Completed by (circle one):: Staff Nurse or RT/ Management- Administration/ NNP /Physician


Please read each statement carefully. Indicate the extent to which you agree or disagree with the statement by circling the appropriate response (1=Disagree, 3=Agree). These answers should reflect how you feel your Neonatal Intensive Care Unit is at the present time, not how you think it might be in the future or how you might wish it to be.

Response Categories:

You should circle Agree when the statement is a generally accurate description of your unit. You should circle Disagree when the description is a generally inaccurate description of your unit. The response Neither Agree or Disagree should be circled when you believe the statement is neither a particularly accurate nor a particularly inaccurate description of your unit. This may occur if there is wide variation in the accuracy of the statement. If you do not have enough information to answer the question, please circle “Don't Know

Unless specified otherwise by the question, please answer as follows:


2=Neither Disagree or Agree


4=Don't know

NICQ2005: Physical Environment Focus Group Senses and Sensibilities: Appendix 2. Implementation worksheet

PBP Neurodevelopmental Bundles and Implementation Strategy Worksheet:

NICQ2005: Physical Environment Focus Group Senses and Sensibilities: Appendix 3. Bedside Audit for Implementation Compliance

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Laudert, S., Liu, W., Blackington, S. et al. Implementing potentially better practices to support the neurodevelopment of infants in the NICU. J Perinatol 27 (Suppl 2), S75–S93 (2007).

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  • collaborative quality improvement
  • neonatal intensive care
  • NIC/Q 2005
  • potentially better practices
  • neurodevelopmental

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