Like so many other aspects of life, COVID-19 has forced medical professionals, and particularly nurses, to develop innovative approaches to our every day care. The NICU is no exception. Recently, we heard from one of the members in our Synapse Community about a novel way they have come up with to manage L&D patients when NICU personnel are needed to attend a high risk delivery.
Red Light, Green Light
Utilizing a color-coding system, perinatal staff including L&D, NICU, and Post Partum are able to communicate clearly regarding the mother’s COVID-19 status and take proper precautions. When a laboring mom is admitted, she undergoes a rapid swab test for COVID in L&D. While results are pending, further delineation of COVID risk is achieved through symptom screening – is the mom symptomatic or asymptomatic? Risk stratification is designated as follows:
Red: Mom COVID positive
Orange: (PUI) Symptomatic mom COVID test pending
Yellow: Asymptomatic mom COVID test pending
Green: Mom COVID negative
A sign is placed on the L&D door to alert caregivers to mom’s status. When NICU is called for a delivery, they are given the L&D room number and COVID status color altering staff to the PPE they will need to safely attend the delivery as well as the type of NICU room, PPE, and testing that will be required should the baby require NICU care. For example, if NICU is called to a delivery for a mom with an orange status, they would respond with full COVID PPE. If they are called to a delivery for a mom with a yellow status, they would attend the delivery adhering to contact/droplet precautions.
Across all risk categories, well babies are staying with mom. What is really interesting is how they’ve approached care of the well baby regarding separation from mom in the postpartum unit. For the highest risk moms, those who are positive for COVID and those who are symptomatic with a pending test, if mom is able to care for the baby, the baby is able to stay with her postpartum. The baby is kept in an isolette in the postpartum room with mom, and full COVID PPE is utilized by caregivers. For asymptomatic moms and those with negative COVID tests, babies stay with mom under standard precautions.
Why can’t we apply the same risk stratification strategy to NICU visitation?
This really got us thinking about the “guilty until proven innocent” approach that so many NICUs are using regarding parental access to their baby.
Shouldn’t we institute screening programs like this one, from a Northern California NICU, to delineate a parent’s risk for COVID-19 and modify visitation accordingly?
For those in the lowest risk categories, and especially those with a negative COVID test, could have unrestricted access to their infant, just like we are, as members of the healthcare team.
We want to hear from you! How is your unit accomplishing COVID-19 risk stratification for mom and baby? We’d love to hear from you! Email us at firstname.lastname@example.org.