P1.165: Implementation of the Goslings Traffic Light System in a Level IV NICU to Facilitate Communication about Infant Readiness for Interaction

Background: Prematurity, infant illness, and prolonged hospitalization may disrupt the parenting role and decrease the quality of parent-infant interaction. Family-centered care studies demonstrate that parental involvement in their infants' care improves their caring abilities and fosters bonding. Sequential MRI scans reveal decreased brain development and lower language assessments in preemies cared for in single-family room (SFR) NICUs. Goslings Family Hour (GFH) was developed to address the need for early language and literacy intervention for medically complex infants and to provide additional parental support in the NICU. GFH uses a traffic light concept for medical providers to communicate an infant’s medical readiness for activities to families. Studies of GFH reveal positive behavioral changes in parent-infant interactions, increased early language and literacy activities, and enhanced confidence. However, one barrier existed to the full implementation of GFH: parents report they are determining their infant’s medical readiness for interaction rather than the medical team doing so.

Methods: This qualitative study was deemed IRB exempt. After designing traffic light signage (TLS) (Figure 1), criteria for implementation (Figure 2), and conducting staff education, we used purposive sampling to conduct semi-structured interviews with parents and medical providers. All participants received a $10 gift card for their time. Interviews were transcribed and coded simultaneously using Atlas.ti. Utilizing grounded theory methodology, the data was analyzed line by line, with codes assigned to responses to capture the phenomena described by participants. To ensure coding reliability, data was co-coded by two researchers. The codes were compared across participants, organized into categories, and further consolidated into concepts, which were ultimately grouped into overarching themes. Data collection continued until thematic saturation was achieved, indicating no new themes emerged.

Results: We achieved thematic saturation after 5 parent and 10 provider interviews. Five prominent themes emerged from the data:
(1) GFH--GFH was viewed as informative and impactful.
(2) Effective Signage--The TLS was described as user friendly and insightful. Participants agreed with color assignment and felt that the signage facilitated communication.
(3) Positive Impact--All parents and providers reported a significant positive impact on parental behavior, and providers stated that the TLS also impacted their behavior.
(4) Barriers--Barriers to implementation included inadequate TLS information and inconsistent TLS use.
(5) Recommendations--Continued use of the TLS was highly recommended. Other recommendations included earlier TLS education for parents, continued provider education and designating the bedside nurse as the responsible provider.

Conclusion: The Goslings TLS is an effective tool that supports education, positive parent and provider behavioral changes, and provider-parent communication in an SFR NICU. To maximize effectiveness, earlier education and improved integration into rounds and workflows were recommended.