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1. Establish that the infant meets the above criteria.
2. Request and receive an order for a PAL Session signed by ARNP or Physician.
3. Begin implementing a PAL session prior to feeding. (Research indicates that infants have the best
outcomes when a PAL session is provided prior to feeding – approximately 30 minutes to 90
minutes prior to feeding.)
4. A PAL session should be implemented for 15 minutes once or twice/day depending on the GA of
the infant. A PAL session should be withdrawn if the infant ceases to suck for 1 minute with mild
stimulation of pacifier movement in his/her mouth or when signs of overstimulation are observed.
5. For the initial PAL session use the lowest criteria or easiest settings on a PAL Player to determine
the infant's beginning sucking behaviors and allow the infant time to learn the music is contingent
on the infant's suck. Infants with neurological damage or failure to demonstrate a suck reflex
should be given longer periods of time at the lowest criteria settings.
6. As the infant begins sucking consistently and showing progress, gradually increase the settings,
increasing the difficulty or criteria for music reinforcement.
7. If the infant is not successful at the increased criteria or settings, return to previous easier setting
for the remainder of the session. Ensure the infant shows success at the lower setting again before
increasing the settings.
8. Continue a PAL Session until infant demonstrates periods of 15 minutes of effective NNS and the
infant's oral feeding improves.
9. Following the PAL session, remove the PAL Sensor from the infant's crib. Remove the Soothie
pacifier from the PAL Sensor, use approved cleaning agents to clean and store the PAL Sensor for
future use by this infant (single-patient-use).
10. Remove the PAL Player from the crib. Use approved cleaning agents wipes to clean the PAL
Player.
11. Store PAL Player unit.
NOTE: If during PAL session another patient is having an alarm needing intervention and no other
caregiver is available to handle the alarm situation, before leaving the patient, the caregiver should assure
the safety of the PAL patient by:
•
Making sure bedrails are up or incubator doors closed.
•
Contain the patient so he/she feels secure.
•
Take PAL Player and PAL Sensor out of the crib/isolette and place on bedside table.
•
Go to patient needing intervention.
•
When patient needing intervention is addressed, return to the patient and continue administering
the PAL session.
9.3 Use of PAL Device for Recording & Using Mother's Voice
As units continue to move to a family center care approach, the use of mother's voice also continues to
increase. While it can seem complicated, it is a simple, easy service that we can provide to our families in
the NICU.
The purpose of utilizing mother's voice is to:
•
Promote mother and infant bonding
•
Provide parent education
•
Empower mother
•
Increase parental involvement in the infant's care
•
Increase the infant's exposure to appropriate auditory stimulation
Participation:
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