Tell us about your unit’s experience with Couplet Care!

***Couplet Care is a model where mothers and babies are cared for together in the same room with considerations for the interdependent needs of the mother and infant, and where gestational siblings are welcomed at the bedside.

Other:

  • It is important to also look at what criteria there is for the mother; for a critically ill mother the couplet care needs to be located at the adult ICU or the maternity unit. When the infant is in need of neonatal intensive care, hopefully the mother’s care can be tailored and located at the infant’s bedside. Care for both patients is organized in the unit responsible for the patient with the most complex medical needs.
  • Any preterm/term infant 30wks and above not requiring mechanical ventilation at the time of admission (but can be requiring CPAP and are not moved if later require ventilation).  Excludes HIE, PPHN, CDH. Specific maternal criteria exist as well due to location off of the postpartum floor.
  • All our infants stay with their mothers
  • All babies are eligible, moms have to be off mag for 8 hours, have their recovery completed (2 hrs), and not be requiring IV antihypertensives. We are a level II progressing to level III this fall and have many questions about what this will look like with higher acuity babies!
  • All neonates admitted to NICU

If your unit utilizes a Couplet Care model, can you tell us how staff are cross-trained? 

  • To a limited extent. There are different teams caring for the mother and the baby. They collaborate but have separate responsibilities. All teams need to know first aid for both patients and to have routines for getting the right team to be alerted in emergency situations (like different sets of alarm systems for the two patients). They are also trained to be able to help each other with delegated tasks.
  • There are separate teams responsible for the care of the mother and the infant respectively. Staff is trained for first aid emergencies of both patients and alarm systems are known and practiced to alert the needed competencies as soon as possible. Staff is also trained to be able to help each other with delegated tasks. For example maternity nurses and midwives can take a blood glucose and monitor clinical parameters of a newborn. NICU staff can give oral analgesic to a mother, remove a drip that is finished and empty a urinary bag. Usually it is the nursing staff that is crossed trained for delegation tasks like this and not the doctors. All working with mothers and newborns should have team training in first aid measures for both patients.
  • Couplet care located in the NICU and mom is staffed by postpartum mother/baby RN and baby staffed by NICU RN.  Available to assist as needed but not specifically cross trained.
  • Maternity has Couplet Care model. NICU does not.
  • NICU nurses on hire are aware that they will cross train to take care of well moms with their baby/babies. Depending on the severity of the infant then a L&D nurse may care for the mom. If the mom is on Mag or too ill for a NICU nurse to care for a L&D nurse will care for the mom on LDRP and the NICU nurse will care for her baby there. We have central monitoring and are on 2 different floors but the  monitors can be seen on both floors.
  • Our unit is only 3 years old and most of our team worked in post-partum previously. This made our transition easy at first as the team needed to learn a few NICU skills, but already had the PP skills. As we have hired additional experienced Level III RN’s, we are not requiring them to learn PP as they will be precepting our current team as we progress to Level III. We have created a Level II/PP team of RN’s that will take low acuity babies and all PP moms. As the educator, I manage their NICU training and work closely with our OB educators who manage the PP training and continuing education. These RN’s get their PP training by spending several weeks working in OB, then completing all ongoing education assigned by that department. They are similar to a little float team! 
  • Once our team is solid in Level III skills, we may revisit upskilling our Level III RN’s to care for PP patients.
  • NICU Staff in turn take care of them.
  • It is challenging – only space for couplet care is on the Mother-Baby floor outside of NICU. There was cross training but more often now our Eat Sleep Console intervention is delivered in the Newborn nursery and if complications beyond ~5 days they need to move up to the NICU.
  • Most of the time L&D staff take care of mother and NICU staff take care of admitted neonates in the same room. All NICU staff are trained in taking care of postpartum mothers also.
  • Interdisciplinary training, in services skills fair