Midwest Nursing Reseach Society

Document Type





MNRS Student Poster Abstract EBP/QI Poster

Title: Plagiocephaly and Associated Head Deformities in the NICU: The PLAY Bundle

Authors: Ashley Kubik, RN, BSN & Jenna Welton, RN, BSN

Description of Students' Role: Two students are conducting this project for their DNP Capstone at the University of Nebraska Medical Center. Both are BSN to DNP students completing the dual Pediatric Acute & Primary Care Nurse Practitioner program. There is equal contribution from both for project development, implementation, data collection, and analysis.

Nature and scope of the project: Premature infants in the Neonatal Intensive Care Unit (NICU) have a greater risk of head asymmetry and related complications. No standardized protocol for positional head deformities exists at Children’s Hospital of Omaha. The Electronic Health Record (EHR) doesn’t optimize head measurement documentation or flag concerning head measurements. Our goal is to reduce the progression of head deformities through education, prevention strategies, and earlier identification and treatment.

Background: Numerous evidence-based interventions demonstrate successful prevention and treatment for head deformities with maximized success when combined. Authors developed an evidence-based bundle comprised of Positioning and PT/OT involvement, Learning, Assistive Devices, and You (PLAY). The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework is utilized.

Project implementation: Data collected during weeks 1-13 (June-September 2022) were under the current standard of care, then the PLAY Bundle was implemented, and data collection will continue through week 26 (December 2022). All NICU patients are eligible for inclusion on a rolling basis. Evaluation Criteria: Paired t-tests will be used for nurse’s knowledge tool, caregiver comfort survey, and nurses’ practice and documentation. PT/OT involvement comparisons pre- and post-bundle will be analyzed using Fisher’s exact test. Descriptive statistics will be utilized for adherence and documentation rates with the addition of PT/OT involvement included. Bundle efficacy will be analyzed using repeated measures ANOVA.

Outcomes: Since project inception, 33 infants have been measured for possible plagiocephaly and associated head deformities with 19 occurring after PLAY Bundle implementation. Under previous standard of care, 34% of patients (n=27) had plagiocephaly documentation while just 7% (n=6) received a PT consultation. Of the NICU patients diagnosed with head deformities since PLAY Bundle implementation, biweekly head measurements improved in 58%, worsened in 20%, worsened then improved in 8%, and stayed the same in 20%.

Recommendations: Preliminary recommendations include EHR optimization and standardized parental education. There is a vital need for a nurse-driven releasable order set with intervention activation when infants meet criteria.