Small Changes, Big Gains: A Quality Improvement Approach to Increasing Responsive Care for Infants and Toddlers with Cancer on the Inpatient Unit

Background: Responsive caregiving supports infant and toddler wellbeing. Yet, based on nursing observational data, a significant number of one institution’s inpatient infant and toddler patients with cancer—who are uniquely vulnerable due to the developmental risks associated with their illness and treatment—were not spoken to or held by their caregiver at any time when nursing was present over the course of day shifts. Objective: This clinical quality improvement project aimed to increase caregiver engagement in responsive interactions during inpatient stays. Methods: The Model for Improvement framework was used. Implementation, evaluation, and reporting followed the SQUIRE 2.0 framework. Root causes were analyzed with fishbone and key driver diagrams. Outcomes were tracked with control charts and percentage of nursing shifts during which responsive care was not observed. Statistical process control was used to study interventions. Results: Two intervention cycles were completed and resulted in significant and meaningful (>1 sigma) reductions in nursing shifts during which infants and toddlers were not spoken to or held. Conclusions: Caregiver psychoeducation interventions increased responsive care of infants and toddlers in our oncology inpatient setting. This low-cost intervention may be adaptable across inpatient settings.