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SECTION F: NEONATAL CARE

All questions in this section are directed at the Level IV NICU you designate in question F1. DO NOT include patients in sites other than the Level IV NICU including those in affiliated programs or hospitals.

F1. Do you have a Level IV1 neonatal intensive care unit (NICU) in your children’s hospital or pediatric program? (Note that you should answer yes to this question if you have been granted Level IV status or currently meet the American Academy of Pediatrics guidelines for a Level IV NICU.) Please answer remaining questions about the Level IV unit specified in this question.

Yes No – Skip to Section G

When responding to questions in this section, we recommend that you consult with the medical director of your Level IV NICU program to ensure accurate answers that are consistent with the intent of the survey.

As data are reviewed, U.S. News may have questions about responses to individual questions or about an entire submission. To ensure communication with the appropriate clinical leader, please provide the following information about the chief of service (or equivalent) for your Level IV NICU program.

Full name:

Title:

Email:

Preferred phone:

REQUIRED: IF NAME, TITLE, EMAIL, OR PHONE=BLANK, DISPLAY: “A response is required for [Name/Title/Email/Phone] prior to submitting the survey. Click “OK” to continue with the survey and answer this question later. Click “Cancel” to provide a response to this question now.”

1 (AAP guidelines, Pediatrics, 2012, 130:587-597)

Last updated: 1/10/2018

F2. Please indicate the current total number of attending/on-staff physicians (excluding fellows)2 who are currently members of the medical staff who provide care at your Level IV NICU. For each category, please indicate the total number of full-time equivalents (FTEs)3 devoted to clinical care. [If none, please enter 0.]

Total Physicians Clinical FTEsa. Pediatric neonatologists (include only

board certified/board eligible4 by the American Board of Pediatrics with subspecialty certification in neonatal-perinatal medicine) ________ ________

b.

Other attending/on-staff physicians (include all other attending/on-staff physicians who are not subspecialty board certified/board eligible in neonatal-perinatal medicine) who independently care for level IV patients ________ ________

VALIDATE: IF F2x1 IS NOT A WHOLE NUMBER, DISPLAY: “F2x (Total

Physicians): Please enter a whole number (no decimals).”

Note: The preceding questions are used to determine eligibility for Neonatal Care. If you leave any part of these questions blank, your hospital will be considered ineligible for the rankings in Neonatal Care.

F2.1 Does your Level IV NICU program have in-house 24x7 coverage provided by board certified/board eligible neonatologists?

Yes No

2 Attending/on-staff physicians include those who have completed their training in their particular medical specialty, are actively providing clinical care to patients, and are currently considered a member of the “medical staff” at the hospital. This may include physicians employed by the hospital, an affiliated university, or some other entity as long as the physician is considered part of the medical staff at the hospital. 3 To calculate physician clinical FTEs, please take the percentage of typical clinical effort that a physician provides to the program and divide by 100. This resulting decimal will be the clinical FTE for this physician. For example, Dr. A spends 75% of his time in clinical care and 25% in research; the clinical FTE for Dr. A would be 0.75 FTE (i.e., 75/100=0.75).4 Note that Board Eligible is now defined by the American Board of Pediatrics as a care provider out of training <6 years; beyond this window, all neonatologists being counted in this question must be board certified to be included. If a provider does not meet the board eligible or board certified criteria, then they may only be counted in F2b.


F3. Does your Level IV NICU program have advanced practitioners (i.e., nurse practitioners, physician assistants, and neonatal hospitalists5) who work in or directly support patient care? If yes, please indicate the average number of patients per physician extender during a typical day shift.

No, we do not have advanced practitioners Yes, < 9 patients per advanced practitioner Yes, 9-15 patients per advanced practitioner Yes, >15 patients per advanced practitioner

F4. Please answer the following questions about the nursing staff that work in or directly support your Level IV NICU program.

Responsea. Number of FTEs6 of direct clinical care RNs ________b. Percent of eligible7 direct clinical care RNs who are nationally certified

in neonatal intensive care (RNC-NIC, NNP-BC, or CCRN) (Number of eligible certified RN / Total # eligible RN’s) ________%

VALIDATE: 0 ≤ F4b ≤ 100; ELSE, DISPLAY: “F4b: Please enter a numeric value between 0 and 100.”

F5. What is the average patient load per neonatologist (include only attending/on-staff physicians8 board certified/board eligible9 by the American Board of Pediatrics with subspecialty certification/eligibility in neonatal-perinatal medicine) in your NICU for week-day shifts?

< 18 patients per neonatologist 18-25 patients per neonatologist >25 patients per neonatologist

F5.1 What is the average patient load per licensed independent practitioner (defined as in-house attending, fellow, resident, or advanced practitioner) cared for on the night shift? [Calculate as the average number of patients in unit at night divided by the average total number of licensed independent practitioners.]

<15 patients per licensed independent practitioner 15-20 patients per licensed independent practitioner >20 patients per licensed independent practitioner

5 Physicians trained in pediatrics, but not board-certified in neonatal-perinatal medicine, who care for patients in the Level IV NICU under the supervision of a neonatologist. Do not include physicians counted in F2.6 Calculate clinical nurse (RN) FTEs based on total paid hours for the period of review divided by 2080.7 For this question, eligible nurses include those who have at least 2 years NICU nursing experience and the specified national certifications in neonatal intensive care.8 Attending/on-staff physicians include those who have completed their training in their particular medical specialty, are actively providing clinical care to patients, and are currently employed by the hospital as a member of the medical staff.9 Note that Board Eligible is now defined by the American Board of Pediatrics as a care provider out of training <6 years; beyond this window, all neonatologists being counted in this question must be board certified to be included.


F6. What was the average daily census10 for your NICU in the last calendar year?

________ NICU average daily census

F7. Does your NICU program provide the following NICU-dedicated11 staff for patient care within the unit?

Yes No

a. NICU-dedicated pharmacist on-site who attends work rounds daily on weekdays with the clinical team ○ ○

b. NICU-dedicated respiratory therapy team who attends work rounds daily on weekdays with the clinical team ○ ○

c. NICU-dedicated registered dieticians who attend work rounds daily on weekdays with the clinical team ○ ○

F7.1 If Yes to F7c, what is the average number of patients per registered dietician?

<20 patients 20-30 patients >30 patients

F8. Are the following family services offered to neonatal patients and their families in your NICU?

Yes Noa. NICU-specific Family Psychosocial Support Program12 ○ ○b. Parental visitation (available 24 hours a day, 7 days a week) ○ ○c. Sibling visitation allowed13 ○ ○d. NICU-specific parent-to-parent support group(s) ○ ○

e. Designated psychologist or psychiatrist available for referrals and consults with parents ○ ○

f. Child Life support team available to the NICU families and staff ○ ○

g. NICU-dedicated multidisciplinary developmental care team14 ○ ○

10 Inpatient days in the NICU divided by 365 or by the number of days that the hospital was open if less than 365.11 Dedicated means that the individual or team that is focused on the care of NICU patients and that they do not provide services elsewhere in the pediatric program.12 To answer “yes” to a NICU-specific Family Psychosocial Support Program the unit must have a NICU-specific Family Psychosocial Support Program that is run by a NICU-dedicated specialist with financial support from the NICU/hospital and which is designed to address family needs distinct from those needs managed by the NICU social workers.13 You may answer Yes if this is normally allowed, but limitations are made during influenza/RSV season.14 To answer “yes” to this question the NICU must have dedicated occupational therapy, physical therapy and feeding/speech specialists providing care in the unit, not just consultative service


F8.1 Does your Level IV NICU have the following elements of a “Safe Sleep” program?Yes No

a. Mandatory Safe Sleep Education for NICU Staff ○ ○

b. Required documentation that safe sleep has been discussed with family prior to discharge ○ ○

c. Policy in place for use of devices (swings, infant seats, etc.) ○ ○

d. Safe Sleep Auditing within the NICU of patient sleep environment and position for patients appropriate for safe sleep practice ○ ○

F9. Does your NICU have a NICU-specific parent advisory committee that meets at least quarterly (or a subcommittee from the larger parent advisory committee) with direct impact to NICU leadership and management decisions?

Yes No

F10. Does your NICU track the proportion of infants discharged on partial or full breast milk to use as a quality metric?

Yes – Go to F10.1 No – Skip to F10.2

F10.1 In the past calendar year, what percentage of infants15 who were admitted at <7 days of age and who were discharged home from the NICU before 120 days of age, were on partial or full human milk feeds at that time of discharge? [Calculate as follows: (1) Determine the number of infants15 who were admitted at <7days of age and who were discharged home from the NICU before 120 days on partial or full human milk feeds at the time of discharge in 2017. (2) Determine the total number of infants15 who were admitted at <7days of age and who were discharged home from the NICU before 120 days. (3) Divide the number of infants home on partial or full human milk feeds at the time of discharge (1) by the total number of infants discharged (2), and multiply by 100. Round your result to 2 decimals.]

______Number of infants on partial or full human milk at discharge in 2017 ______Number of infants discharged in 2017______% of infants discharged on partial or full human milk feedings

VALIDATE: IF F10.1 (1) > F10.1 (2), DISPLAY: Please check your responses. The number of infants on milk at discharge cannot be higher than the number of infants discharged.”IF F10.1 (1) or F10.1 (2) IS NOT A WHOLE NUMBER, DISPLAY: “F10.1x: Please enter a whole number (no decimals).”

AUTOCALC: F10.1 (3) = [F10.1 (1) / F10.1 (2)]*1000

15 Infants for whom there are definitive contraindications to breastfeeding (i.e., HIV positive or substance abusing mother) should be excluded from the numerator and the denominator.


F10.2 Does your hospital/NICU offer a dedicated area within the facility but away from the bedside for milk and formula preparation? 16 [To answer “Yes” this area must meet both of the following criteria: a) Infant feeding preparation room using the aseptic technique (Clean “No-Touch”) technique; b) The room requires restricted access and healthy personnel; with no other activity occurring in the room.]

Yes No

F10.3 Does your NICU program offer the following for nutrition and breastfeeding? Yes No

a. NICU-dedicated lactation specialists who have the International Board-Certified Lactation Consultants (IBCLC) certification or the Breastfeeding Counselor Certification (CBC)

○ ○

b. Cohort of NICU RNs specially trained in lactation counseling ○ ○c. NICU specific Breast Milk committee ○ ○d. Process to rent breast pumps to families ○ ○e. NICU specific risk reduction program that includes processes

designed to reduce breast milk errors ○ ○

f. Donor breast milk program with written institution-specific criteria for the initiation and discontinuation of donor breast milk ○ ○

SKIP LOGIC: IF F10.3e=Yes, GO TO F10.4; ELSE SKIP TO F10.5

F10.4 Which of the following elements does your NICU specific risk reduction program include?

Yes No

a. Bar coding system, such as bedside scanning, for correct breast milk identification ○ ○

b. Dedicated breast milk technician who prepares milk for proper identification and distribution ○ ○

F10.5. Does your NICU program track the breast milk administration error rate (e.g., wrong breast milk given to patient)?

Yes No – Skip to F11

16 This would be an area in NICU, pharmacy or a dedicated formula or milk lab that meets the ADA guidelines found in the publication Robbins ST, Meyers R. (2011). Infant Feedings: Guidelines for Preparation of Human Milk and formula in Health Care facilities. 2nd ed. Chicago: American Dietetic Association.


F10.6 If yes to F10.5, please report the number of breast milk administration errors, the breast milk feeding patient days in infants admitted at <7 days of age and discharged home at < 120 days, and the breast milk administration error rate for the last calendar year? [Calculate as follows: (1) Determine the number of breast milk administration errors in 2017. (2) Determine the total number of breast-feeding patient days17 in 2017. (3) Divide the number of administration errors by the number of breast-feeding patient days, and multiply by 1,000. Round your result to 2 decimals.]

________ (1) Breast milk administration errors

________ (2) Breast milk feeding patient days

________ (3) Breast milk administration error rate

WARNING: IF F10.5=Yes AND F10.6 (2) = (0 OR BLANK), DISPLAY: “F10.6 (BM feeding patient days): Please provide a value greater than 0 or answer No to F10.5.”

VALIDATE: IF F10.6 (1) > F10.6 (2), DISPLAY: Please check your responses. The number of administration errors is higher than the number of feeding patient days.”IF F10.6 (1) or F10.6 (2) IS NOT A WHOLE NUMBER, DISPLAY: “F10.6x: Please enter a whole number (no decimals).”

AUTOCALC:F10.6 (3) = [F10.6 (1) / F10.6 (2)]*1000

F11. Does your program have NICU-dedicated social workers?18


F11.1 What is the average number of patients per social worker?

<15 patients per social worker 15-25 patients per social worker >25 patients per social worker

17 The total number of breast milk feeding days equals the sum of the lengths of stay (LOS) in days for all infants admitted <7 days and discharged home <120 days from the NICU on breast milk feeds.18 Do not include case managers in your response to this and the follow-up question about social workers.


F12. Are the following available on-site to patients in your NICU?

Yes Noa. Continuous video electroencephalograph (EEG) monitoring19 and

reading20 with pediatric neurology support with telemetry capability 24/7

○ ○

b. Virology laboratory with weekday 24-hour availability21 ○ ○c. Onsite genetic specialists with expertise in interpreting and

counseling parents and family members about exome sequencing results for diagnosis of rare, Mendelian phenotypes

○ ○

d. Less than 24-hour turnaround time for comprehensive respiratory viral molecular testing ○ ○

e. Less than 24-hour turnaround time for amino acid analysis ○ ○f. Less than 24-hour turnaround time for urine organic acid analysis ○ ○

F13. Does your hospital provide a specific transport team with each of the following members who have at least 1 year of NICU level III or IV experience?

Yes Noa. A Medical Director who is board-certified in Neonatal-Perinatal

Medicine ○ ○

b. At least 2 clinicians (e.g., RN, RT, MD, DO, NNP, PA) on each transport who are non-drivers ○ ○

c. All RN’s and RT’s have at least 1 year of NICU level III or IV experience ○ ○

d. Neonatal transport team is immediately22 available 24 x 7 to respond to emergent neonatal transports ○ ○

e. Active servo-controlled cooling on transport for term and near-term infants with hypoxic ischemic encephalopathy23 ○ ○

F13.1 Does your Level IV NICU program track admission temperature for infants cooled during transport?

Yes—Go to Question F13.2 No—Skip to Question F13.3

19 EEG is a technology for measuring electrical activity produced by the brain, as recorded from electrodes placed on the scalp. EEG monitoring provides the ability to collect the brain’s electrical activity continuously to help detect and diagnose neurological problems.20 EEG reading is done by a board-certified physician or psychologist trained in diagnosing disorders related to brain activity. 21 This is a diagnostic laboratory that supports the NICU by conducting culture and tissue studies to determine the virological conditions. Laboratory should be able to complete one or more of the following tests: HSV PCR from CSF, HSV PCR from blood, or direct HSV antigen testing for skin lesions.22 Note that transport staff taking call from home would not qualify as immediately available.23 To answer yes to this question, the infant must be actively cooled using equipment that includes continuous monitoring of infant temperature, with feedback of infant temperature to the cooling device; the device must auto-regulate to achieve the desired target infant temperature.


F13.2 What percentage of infants cooled during transport in the past calendar year had admission temperatures between 33.0 and 34.5 degrees centigrade?

<40% 40-80% >80% Unable to report

F13.3 Does your NICU have the capability of providing inhaled nitric oxide therapy during transport with high-risk pre-ECMO patients whenever indicated?

Yes No

F13.4 What percentage of emergent neonatal transports are dispatched within 30 minutes of the call being logged as received?

<40% 40-80% >80% Unable to report


F14. Are the following specialized, multidisciplinary treatment teams/programs available to patients in your NICU?

Yes Noa. Craniofacial team24 (and follow-up clinic/program) ○ ○b. Spina bifida team25 (and follow-up clinic/program) ○ ○c. Comprehensive retinopathy of prematurity (ROP) program26 ○ ○d. Extracorporeal membrane oxygenation (ECMO) team with

neonatologists managing or co-managing the patient 27 ○ ○

e. Neonatal-neuro intensive care program28 ○ ○f. Palliative care program29 that includes some NICU-specific members ○ ○g. Micrognathia team30 ○ ○h. Multidisciplinary team31 for the in-hospital care of the chronic lung

disease (CLD) patient ○ ○

i. Multidisciplinary team32 for the review of fetal cases with the diagnosis of congenital diaphragmatic hernia (CDH) who develop delivery and post-delivery care plans

○ ○

j. Multidisciplinary team33 for the in-hospital and post-discharge care of infants with chronic pulmonary hypertension ○ ○

k. Neonatal dialysis team34 with the ability to conduct peritoneal and hemodialysis, continuous renal replacement therapy, and plasmapheresis ○ ○

l. Multidisciplinary team 35 for follow-up with congenital diaphragmatic hernia (CDH) patients after discharge ○ ○

24 To answer “Yes,” the team must include a pediatric plastic surgeon, pediatric neurosurgeon, pediatric otolaryngologist, social worker, and case manager.25 To answer “Yes,” the team must include a pediatric neurosurgeon, pediatric urologist, pediatric orthopedist, pediatric physical therapist (or physiatrist), and nurse coordinator.26 To answer “Yes,” the team must include a coordinator as well as a pediatric ophthalmologist and retinal specialist with experience treating ROP.27 To answer “Yes,” the team must include a medical director, clinical manager, neonatal respiratory team, pediatric respiratory team, and a neonatal/pediatric cardiac team.28 To answer “yes,” the team should include a pediatric neurologist, pediatric neuro-radiologist and a neonatologist with experience in neonatal-neuro intensive care who conduct multi-disciplinary reviews and perform consultations.29 To answer “Yes,” the program should have individuals trained in palliative care who organize clinical protocols, educate staff, work with hospital palliative care team, etc.; at least one or more members of the team must have NICU-specific training in the support of NICU patients and families. The program may be part of a larger institutional palliative care team as long as it meets the above requirements.30 To answer “Yes,” the team must include a pediatric ENT specialist or pediatric plastic surgeon and a nurse coordinator who has expertise in conducting surgical care and follow-up for mandibular distraction, tongue-lip adhesion, and tracheostomy procedures.31 Team must consist of a dedicated pulmonary medicine physician, neonatologist, and nutritionist.32 Team must consist of a dedicated pediatric surgeon, dedicated neonatologist, maternal-fetal medicine specialists, and a radiologist with the capability to interpret fetal MRI, and a fetal echo cardiologist.33 Team must consist of a pediatric cardiologist specializing in care of the chronic PH patient, neonatologist, and nutritionist.34 Team must consist of a pediatric nephrologist, pediatric surgeon, and neonatologist.35 To answer “Yes” to this question the follow-up program for infants with CDH must routinely include surgery, nutrition, neurodevelopmental specialists and pulmonology and routinely follow infants for at least the first 3 years after discharge.


F15. Are the following organized care teams offered by your hospital to transition patients from your NICU to home?

Yes Noa. Metabolic team36 ○ ○b. Bowel rehabilitation team37 consisting of home TPN management

and home enteral feeding management ○ ○

c. Home ventilator management team38 ○ ○d. Neuro-developmental follow-up clinic39 for premature/high risk

NICU patients ○ ○

e. Neuro-developmental clinic40 for high risk congenital heart neonatal patients ○ ○

F16. How many unique patients—referred or inborn (patients that were not referred to another NICU or unit within your hospital for care other than step-down care)—received care in your level IV NICU for the following conditions or therapies during the past year? [If none, please enter 0.]

Unique patientsa. Congenital diaphragmatic hernia (See code list) ________b. Hirschsprung’s disease (See code list) ________c. Hypothermia treatment AND hypoxic ischemic encephalopathy or

severe birth asphyxia (See code list – must have diagnosis and procedure codes) ________

d. Open Neural Tube defect (See code list) ________e. Gastroschisis (See code list) ________f. Tracheoesophageal fistula (TEF) or esophageal atresia (See code list) ________g. Omphalocele (See code list) ________h. Duodenal atresia, jejunal atreasia, or ileal atresia (See code list) ________i. Imperforate anus (See code list) ________j. Extracorporeal life support therapy (See code list) ________

VALIDATE: IF F16x IS NOT A WHOLE NUMBER, DISPLAY: “F16x: Please enter a whole number (no decimals).”

F16.1. Do all surgical patients in your NICU have either a mandatory neonatal consult or a neonatologist co-managing their care?

Yes No

36 To answer “Yes,” the team must include a geneticist, metabolic specialist, developmental specialist, and nutritionist.37 To answer “Yes,” the team must include a pediatric gastroenterologist (or other metabolic specialist), social worker, and nutritionist38 To answer “Yes,” the team must include a pediatric pulmonologist, social worker, and case manager.39 A program focused on premature/high risk NICU patients led by a neuro-developmental specialist (a neonatologist with training in neurological care, a pediatric neurologist specializing in neonatal care, or a neurodevelopmental psychologist) providing neurodevelopmental evaluation, along with integrated occupational therapy, physical therapy, speech evaluations, as needed along with social work support for families.40 A program focused on high risk congenital heart NICU patients led by a neuro-developmental specialist (a neonatologist with training in neurological care, a pediatric neurologist specializing in neonatal care, or a neurodevelopmental psychologist) providing neurodevelopmental evaluation, a cardiologist, and integrated occupational therapy, physical therapy, speech evaluations, as needed along with social work support for families.


F16.2 What percentage of anesthesiologists who provide care for your NICU patients, have board-certification or are board-eligible in pediatric anesthesia?

_______ %

VALIDATE: 0 ≤ F16.2 ≤ 100. ELSE DISPLAY: “F16.2: Please enter a numeric value between 0 and 100.”

F17. Does your hospital provide a cardiac intensive care unit (CICU)41 where newborn infants < 28 days of age needing specialized care for heart conditions are cared for?

Yes—Go to Question F18 No—Skip to Question F20

F18. Does your NICU program engage in the following interaction with your hospital’s CICU?

Yes Noa. All preterm42 cardiac patients < 28 days of age receive a

neonatology consult ○ ○

b. All newborn cardiac patients < 28 days of age (preterm and full term) receive a neonatology consult ○ ○

F19. This question was moved to the Congenital Cardiology and Cardiothoracic Surgery section of the survey.

F20. Does your hospital provide a percutaneous intravenous central catheter (PICC) team with specialized training in placing and maintaining PICC lines in NICU patients?

Yes—Go to Question F20.1 No—Go to Question F21

F20.1 If yes, what coverage model does the PICC team provide?

24/7 PICC line placement services Day shift PICC line placement services only Other coverage model

F21. Does your hospital provide a simulation/training laboratory (or training center) with NICU procedures or code simulation programs?

Yes No

41 Define CICU as a separate critical care unit from the NICU and PICU for the full care of the neonatal/pediatric cardiac patient, (e.g., pre and postoperative care of the neonatal/pediatric cardiac patient)42 Note that “preterm” refers to patients that had less than 37 weeks of gestation.


F22. Does your hospital mandate that core NICU staff participate in multidisciplinary training at least once every 2 years in each of the following areas?

Yes Noa. Neonatal mock – unplanned code response in the NICU ○ ○b. Arrhythmia treatment including use of a defibrillator ○ ○c. Simulation of emergency evacuation of the NICU ○ ○d. Simulation for maintenance of Neonatal Resuscitation Program (NRP)

and/or Pediatric Advanced Life Support (PALS) active status ○ ○

e. ECMO emergency simulation training ○ ○f. Exchange transfusion simulation or just in time training using a multi-

disciplinary model, e.g., RN and MDs together ○ ○

g. Other training (specify below) ○ ○

F22.1. If “yes” to F22g, please specify what these “other” protocols NICU staff are trained in:

F23. For your fellows and your advanced practitioners (NNP/PA’s), does your Neonatology Division track NICU procedure/protocol proficiency for chest tube placement, intubation, and neonatal resuscitation at least every 2 years by use of procedure count or simulation training?

Yes – Go to F23.1 No – Skip to F23.2

F23.1. For each of the following NICU procedures/protocols, what percentage of neonatal fellows and advanced practitioners completed their proficiency requirement (performance of procedure, simulation, or other training) in the last two calendar years? [If training is not offered, please leave blank.]

Neonatal Fellows

Advanced Practitioner

s43

a. Chest tube placement ________% ________%b.

Intubation ________% ________%

c. Neonatal resuscitation program (NRP) ________% ________%

VALIDATE: 0 ≤ F23.1x ≤ 100. ELSE DISPLAY: “F23.1x: Please enter a numeric value between 0 and 100.”

43 This includes Neonatal Nurse Practitioners, Physician Assistants, and Neonatal Hospitalists.


F23.2 Does your hospital track the percentage of current attending physicians in the Level IV NICU that have completed simulation or other training to refresh their skills within the last 24 months documenting competency in the following procedures? [If none, please enter 0.]

Yes Noa. Chest tube placement ○ ○b. Pericardiocentesis ○ ○c. Abdominal paracentesis ○ ○d. Double volume exchange transfusion ○ ○e. Cardioversion ○ ○

F24. Does your NICU program participate in any of the following clinical research or data exchange programs?

Yes Noa. Vermont Oxford Network44 Expanded Database for infants > 1,500

grams or the Children’s Hospitals Neonatal Database (CHND)45 ○ ○

b. Extracorporeal Life Support Organization (ELSO)46 data exchange network/registry ○ ○

c. Other clinical research or data exchange program ○ ○

F24.1. If “yes” to F24c, please specify what other programs you participate in:

F25. Does your NICU program participate in any clinical research studies registered on clinical trials.gov that allow your patients access to novel or experimental treatment options?

Yes No

F26. Does your hospital track central line associated blood stream infections (CLABSI) rates for your Level IV NICU patients?


44 See http://www.vtoxford.org.45 See https://www.childrenshospitals.org/. Note that participating in the CHA administrative dataset PHIS cannot be used to answer yes to this question. The PHIS is not a dataset designed for quality improvement and does not have QI collaborative activities associated with the dataset participation; if PHIS is included in the write in section it should not be valued as is participation in VON and /or CHND.46 See http://www.elso.org/


http://www.elso.org/

https://www.childrenshospitals.org/

http://www.vtoxford.org/

F26.1 Please report the number of CLABSI events, central line days, and CLABSI rate per 1,000 central line days for your NICU in the last calendar year? [Calculate as follows: (1) Determine the number of CLABSI events according to NHSN guidelines. (2) Determine the total number of central line/umbilical line days47 in 2017. (3) Divide CLABSI events by central lines days and multiply by 1,000. Round your result to 2 decimals.]

________ (1) CLABSI events________ (2) Central line days________ (3) CLABSI rate

WARNING: If F26=Yes AND F26.1 (2) = (0 OR BLANK), DISPLAY, “F26.1 (central line days)): Please provide a value greater than 0 or answer No to F26.”

VALIDATE: IF F26.1 (1) or F26.1 (2) IS NOT A WHOLE NUMBER, DISPLAY: “F26.1 (x): Please enter a whole number (no decimals).”IF F26.1 (1) > F26.1 (2), DISPLAY: F26.1: Please check your responses. The number of CLABSI events is higher than the number of central line days.”

AUTOCALC:F26.1 (3) = [F26.1 (1) / F26.1 (2)]*1000

F27. Is your NICU program currently engaged in any of the following activities?

Yes Noa. Developed and implemented a written plan for program review and

quality improvement ○ ○

b. Determined appropriate data-based performance metrics for clinical quality ○ ○

c. Regularly tracked patient data (e.g., diagnoses, treatment plans, test results, readmission rates, immunization at discharge, percent discharge on breast milk, etc.) and other supporting information to measure progress against your clinical quality performance metrics

○ ○

d. Presented results of your program’s clinical quality performance metrics to your clinical staff on a regular basis ○ ○

e. Participated in one or more quality improvement initiatives specific to neonatal care ○ ○

F27.1. If “yes” to any part of F27, please describe one quality improvement initiative and how it improved the quality of your program in the last calendar year. [To receive credit, you must discuss what actions your hospital took as a result of this quality initiative and the impact it had on your program.]

47 According to NHSN guidelines, a patient with one or more central lines on a given day equals 1 central line day. Provide the composite CLABSI rate for all umbilical and central venous catheters for your pediatric service.


F28. Does your NICU program have a specified Quality Improvement (QI)/safety leader(s) with training in QI/outcome procedures? If yes, how much of their time is dedicated to QI and safety in the NICU?

Yes, > 0.75 FTE Yes, 0.50-0.74 FTE Yes, 0.26-0.49 FTE Yes, < 0.25 FTE No

F28.1 In the last calendar year, did you have a parent/family member of a former NICU patient involved in one or more initiatives as an integral member of the QI/safety team?

Yes No

F29. Do your physicians and advanced practitioners (e.g., nurse practitioners and physician assistants) in your NICU program use ICU-focused standardized hand-off tools (e.g., SBAR, 5-Ps or other) to inform clinical staff during team transitions between night/day/weekend shifts about the patient and care received?


F29.1 Which of the following standardized hand-off tools does your NICU program use to inform clinical staff during team transitions? [Check all that apply.]

Shift hand-off (a standard hand-off tool used at the time of change of shift change for clinical teams)

Team change hand-off (e.g., end of clinic rotation) (a standardized tool used at the time of team change, e.g., end of the month team change)

Pre-op hand-off from neonatology to surgery & anesthesia (i.e., multidisciplinary hand-off tool used before surgery to assure pertinent information is passed on to the surgery team regarding the patient)

Post-op hand-off tool from operating room staff to neonatology nurse or neonatology attending (e.g., multidisciplinary hand-off tool used post-operatively to assure all pertinent information that occurred in the surgery arena is passed on to the clinical team caring for the patient)

F30. Do nurses in your NICU program use ICU-focused standardized hand-off tools (e.g., SBAR, 5-Ps or other) to inform clinical staff during team transitions between night/day/weekend shifts about the patient and care received?



F30.1 If Yes, which of the following standardized hand-off tools do nurses in your NICU program use to inform clinical staff during team transitions? [Check all that apply.]

Shift hand-off (a standard hand-off tool used at the time of change of shift change for clinical teams)

Pre-op hand-off from neonatology to surgery & anesthesia (i.e., multidisciplinary hand-off tool used before surgery to assure pertinent information is passed on to the surgery team regarding the patient)

Post-op hand-off tool from operating room staff to neonatology nurse or neonatology attending (e.g., multidisciplinary hand-off tool used post-operatively to assure all pertinent information that occurred in the surgery arena is passed on to the clinical team caring for the patient)

F31. Does your NICU program track patients’ first postoperative temperatures and use it as a quality metric?48


F31.1 If Yes, what percentage49 of patient first postoperative temperatures (done within 60 min)49 were < 36°C (<96.8°F) in the past year?

________%

WARNING: IF F31=Yes AND F31.1 = BLANK, DISPLAY: “F31.1: Please enter a value or answer No to F31.”

VALIDATE: 0 ≤ F31.1 ≤ 100. ELSE DISPLAY: “F31.1: Please enter a numeric value between 0 and 100.”

F32. Do you track unintended extubation (invasive airway loss in infants without a tracheostomy) in patients who are being treated in the NICU?

Yes No – Skip to F33.2

48 The first postoperative temperature is the first temperature (done within 60 minute) on return to the NICU after a patient has received an operating room (OR) procedure or the first temperature following an in-NICU operative procedure after handoff from anesthesiology. Do not include (in numerator or denominator) if first temperature is measured beyond 60 minutes.49 Note that patients who have recently undergone open heart cardiac surgery and are on intentional body cooling therapy should be excluded from numerator and denominator.


F32.1 If Yes to F32, please report the number of unintended extubations, patient ventilator days, and the rate of unintended extubations? [Calculate as follows: (1) Determine the number of unintended extubations in 2017 – excluding infants with a tracheostomy. (2) Determine the total number of patient ventilator days in 2017 – again, excluding infants with tracheostomies. (3) Divide the number of unintended extubations by the patient ventilator days and multiply by 100. Round your result to 2 decimals.]

________ (1) Unintended extubations

________ (2) Ventilator days

________ (3) Unintended extubation rate

WARNING: IF F32=YES AND F32.1 (2) = (0 OR BLANK), DISPLAY: “F32.1 (Ventilator days): Please provide a value greater than 0 or answer No to F32.”

VALIDATE: IF F32.1 (1) or F32.1 (2) IS NOT A WHOLE NUMBER, DISPLAY: “F32.1x: Please enter a whole number (no decimals).”IF F32.1 (1) > F32.1 (2), DISPLAY: “Please check your responses. The number of unintended extubations is higher than the number of ventilator days.”

AUTOCALC:F32.1 (3) = [F32.1 (1) / F32.1 (2)]*100

F32.2 What is your quality review process for cases of unintended extubation? Check all that apply.

We do not have a quality review process Prospective Mini-RCA50 review within 12 hours of the event Multidisciplinary team retrospective review at least weekly Multidisciplinary team retrospective review, but less frequently than weekly

F33. Question removed from the survey.

F33.1 Question removed from the survey.

F33.2 Do you have a multidisciplinary review of all unplanned readmissions cases to determine if they were preventable?

Yes No

50 A mini root cause analysis (RCA) is a standardized focused review documented by the bedside caretakers following an event to determine the causes of the problem and possible solutions. This typically involves a treating nurse, physician, and others involved in the incident. The results of the review are reported to a NICU specific quality improvement team for review and development of action plan.


F34. Do have the following available for very-low-birth-weight (VLBW, <1,500 grams) and low gestational age (GA, <29 weeks) infants admitted to your NICU within 30 days of birth?

Yes Noa. Starter protein solution available on day of admission ○ ○b. Very low birth weight feeding protocol ○ ○c. “Kangaroo care” routinely provided for infants receiving mechanical

ventilation ○ ○

F34.1 Does your NICU program have or is it associated with a fetal diagnosis and counselling program51?

Yes, either onsite or at another facility—Go to F34.2 No—Skip to F35

F34.2 Is a prenatal consultation with neonatology mandatory when the postnatal patient management plan requires care in the Level IV NICU?

Yes No

F34.3 Does your Level IV NICU hold multidisciplinary patient management conferences to discuss plans for the delivery and early NICU management of fetuses with congenital abnormalities?

Yes, weekly Yes, monthly Yes, less frequently than monthly No

F34.4 When fetuses are expected to require care in the Level IV NICU, do you offer family meetings/counseling that include neonatologists, genetic counselors and relevant subspecialists?

Yes No

F34.5 Does your hospital offer a fetal MRI program for assessment of fetal neurologic, thoracic and abdominal anomalies? Yes No

51 To answer yes to this question, the program must include at minimum maternal-fetal medicine physicians, pediatric surgeons, geneticists, genetic counselors, neonatologists, palliative care specialists, psychosocial support services for parents and a dedicated program coordinator.


Note that F35-F36 have been renumbered.

F35. Does your NICU or hospital have a medication error reporting system/database?

Yes – Go to F35.1 No – Skip to F37

F35.1. If yes, does your NICU have a formalized process for evaluating medication errors?

Yes No

F36. Does your NICU provide prescriber directed feedback for medication prescribing errors?

Yes No

F37. Does your NICU audit hand hygiene compliance rates for providers (MDs, RNs, and RTs) by electronic monitoring or direct observation52 (including secret shoppers) using a standard tool/form?

Yes, via electronic monitoring or direct observation (including secret shoppers) No – Skip to Question F38

F37.1. What were the numbers for the total hand hygiene compliance opportunities completed for your NICU in the last calendar year?

Valuesa. Number of compliant hand hygiene opportunities observed in

the NICU ________

b. Total number of hand hygiene opportunities observed in the NICU ________

WARNING: IF F37=Yes AND F37.1b = (0 OR BLANK), DISPLAY: “F37.1b: Please enter a value greater than 0 or answer No to F37.”

VALIDATE: IF F37.1x IS NOT A WHOLE NUMBER, DISPLAY: “F37.1x: Please enter a whole number (no decimals).”IF F37.1a > F37.1b, DISPLAY: “F37.1: Please check your responses. The number of compliant opportunities cannot be greater than the number of opportunities observed.”

52 Direct observers (including secret shoppers) are individuals who are trained hand hygiene monitors. This should not include patient or family observations.


F38. Do you have written standardized guidelines for antibiotic use in the following situations?

Yes Noa. Surgical NEC repair or drain placement ○ ○b. Small bowel atresia repair ○ ○c. Gastroschisis abdominal closure ○ ○d. Medical necrotizing enterocolitis ○ ○e. Culture negative sepsis ○ ○

SKIP LOGIC: IF F38a AND F38b AND F38c AND F38d AND F38e = YES, THEN GO TO F39. ELSE, GO TO F40.

F39. If yes to all of F38, does your NICU Level IV have a process to measure compliance with all guidelines listed in F38?

Yes No

F40. What percentage of all infants discharged or transferred to another unit or facility in the past 12 months from your NICU Level IV had the following growth metrics recorded within 7 days prior to (before) of discharge or transfer? [Calculate percentage as (1) the number of infants with growth metric recorded within 7 days of discharge or transfer in the past 12 months, by (2) the total number of infants discharged or transferred in the past 12 months, (3) multiplied by 100.]

Percentagea. Weight ________%b. Length ________%c. Head circumference ________%

F41. Does your hospital measure length of infants in your Level IV NICU with a length board?

Yes No


The following are being collected for information purposes only. They will not be factored into the rankings in 2018-19.

F42. Please indicate whether your NICU Level IV could provide the following information if requested on the 2019-20 survey:

Yes, with no

difficulty

Yes, with some

difficulty

Yes, with great

difficulty Noa. Number and percentage of babies

positioned according to safe sleep practices

○ ○ ○ ○

b. The median hospital length of stay for patients with the select diagnoses in F16

○ ○ ○ ○

c. Length of time to full enteral feeds for patients >36 6/7 weeks gestational age who have a diagnosis of gastroschisis

○ ○ ○ ○

d. Data on the weight and length at birth and discharge from the NICU for patients with the select diagnoses in F16

○ ○ ○ ○

COMMENTS FOR SECTION F:If needed, you may provide clarifications to the responses you provided to the questions asked in this section only. All other comments, suggestions or questions should be sent to [email protected].


u · web view[calculate as follows: (1) determine the number of infants15 who were admitted...

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