Implementing the Infant Positioning Assessment Tool in a Neonatal Intensive Care Unit

Abstract

Problem: Infants in the neonatal intensive care unit (NICU) are at increased risk for long-term complications and disability. Developmentally supportive positioning improves neurodevelopmental outcomes in this patient population. Infants hospitalized in NICUs with standardized positioning practices benefit from enhanced developmental outcomes. The valid and reliable Infant Positioning Assessment Tool (IPAT) promotes appropriate infant positioning and encourages caregiver accountability in developmentally supportive positioning practices when used with bedside education. In an academic community medical center NICU, there was no standardized positioning practice in place. Baseline data indicated that 75.1% of infants were being positioned in a developmentally supportive manner. Purpose: The purpose of this quality improvement project was to implement the IPAT to improve consistency in developmentally supportive positioning by promoting appropriate positioning and encouraging accountability in positioning practices. The goal was for 100% of eligible patients to have an acceptable IPAT score of ≥9 by completion of the implementation period. Methods: The project took place in a 26 bed, Level III NICU from November 2021 to January 2022. All infants over 32 weeks gestation, 1,500 grams, past the first 72 hours of life, and admitted to the unit for more than one twelve-hour shift were eligible. Implementation involved a bedside IPAT reference, an online educational training module, informational reference posters, and ongoing bedside education. Data was collected semiweekly on IPAT scores of eligible patients once per shift. A percentage of IPAT scores ≥9 was calculated for weekly averages.