A Quality Improvement (QI) Initiative to Improve Discharge Preparedness for Preterm Neonates Using NICU-PDPS in a Tertiary NICU in India

Abstract

Objective

To develop and implement a discharge preparedness scale and protocol for preterm neonates in order to improve discharge preparedness by 25% from the pre-assessment, as measured by scores on the neonatal intensive care unit parent discharge preparedness scale (NICU-PDPS).

Materials and Methods

A quality improvement (QI) study using the plan, do, study, act (PDSA) model was conducted in the neonatal units of a tertiary care center in North India from July to October 2024. A total of 50 healthcare professionals (HCPs) and 80 parents of preterm neonates were enrolled. The study was conducted in three phases: pre-assessment, development of the protocol, and the implementation phase. Pre-assessment was done using the NICU-PDPS and the observation checklist. Focus group discussions (FGDs) were conducted with HCPs. Based on the pre-assessment and FGDs with HCPs and parents, root-cause analysis, the identified problems were placed in Eisenhower’s matrix, and discharge preparedness protocol development and implementation were chosen as a change. Three PDSA cycles were conducted. Adherence to the discharge preparedness protocol was measured by assessing scores on the NICU-PDPS and the observation checklist.

Results

Discharge preparedness information provided to parents increased substantially, from 37.75% at baseline to 64.42% after the third PDSA cycle, reflecting a 26.6% improvement in the communication of essential information and skills by HCPs. The mean NICU-PDPS score also improved, rising from 80.6 at baseline to 128.2 after the third PDSA cycle.

Conclusion

The QI study has successfully improved the discharge preparedness for preterm neonates by enhancing the level of communication of essential information and skills to parents.