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Delay the Baths. Anne Marie Henri, RN, BSN Nurse Manager Mother Baby Units Boston Medical Center. Boston Medical Center. Urban setting (Boston) Academic teaching hospital Strong affiliations with neighborhood health centers Births per year: About 2,500 Maternity unit on two floors

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delay the baths
Delay the Baths

Anne Marie Henri, RN, BSN

Nurse Manager

Mother Baby Units

Boston Medical Center

boston medical center
Boston Medical Center
  • Urban setting (Boston)
  • Academic teaching hospital
    • Strong affiliations with neighborhood health centers
  • Births per year: About 2,500
  • Maternity unit on two floors
    • 17 (4th floor) and 15 (3rd floor) private rooms
  • NICU: Level 3, 12 beds
  • Step Down Unit: Level 2, 6 beds
delay the bath initiative
Delay the Bath Initiative
  • Background: After birth, a baby’s blood glucose level reaches it’s lowest point at about 2 hours of life
  • Our practice for years has been to bathe babies at 2 hours of life or when a stable temperature (>97.6 ax) achieved
    • We would sponge bathe the babies body, wash the hair under the facet, and then place the baby on the warmer
  • With new private rooms came the opportunity to bathe babies in their rooms without taking them to the nursery
  • Also the opportunity to review the best time to bathe
challenges
Challenges
  • MDs on board with delaying the bath
  • Staff nurses were not enthused for the following reasons:
    • “Gooky”
    • “Smelly”
    • “Parents will hate it”
    • “Infections”
    • “It’s not the way we do things”
how we did it
How we did it
  • Lots of discussion and coaxing
  • Finally, we picked a GO date
    • On May 10, 2010, the Delay the Bath Initiative would begin
  • Baths would be delayed until infant 12 hours of life
    • Except if history of maternal HIV+, hepatitis B or C positive
  • Then after the the bath, infant placed skin-to-skin on mother’s chest
lessons learned
Lessons Learned
  • Change is hard. Discuss, review evidence-based practice, discuss again and then at some point you just gotta GO
  • Parents love it. No complaints. Great opportunity to teach about baths. Great opportunity to reinforce importance of and teach about skin-to-skin, bonding and breastfeeding
  • Hypoglycemia has almost vanished (?TTN?)
    • Study underway
  • At UCSD they don’t bathe babies at all