Abstract
Background:
St. Elizabeth Level 3 NICU (28-bed) in 2016 had a chronic lung disease incidence rate of 48% in our very low birth weight (VLBW) population, above the Vermont Oxford National (VON) average of 23%. To improve quality outcomes in our patient population we standardized our treatment protocols based on evidence-based literature, which is very limited to the NICU population. We also had a significant high incidence rate of device-related pressure injuries and unplanned extubations (UEs) in conjunction with our chronic lung disease rate. The NICU team needed to standardize our approach in care with our providers, nurses, pharmacy, and respiratory team to achieve quality improvement outcomes.
Methods:
The RT NICU Team in collaboration with the NICU medical directors created a standard CPAP protocol that included specific criteria for any patient below 34 weeks’ gestation. The RT NICU team also created a skin safety score based on best practices to prevent hospital-acquired pressure injuries to prevent patients from being removed from CPAP. The team created a report through the electronic medical records (EMR) to be able to provide real time information to discuss CPAP and skin criteria for patients each shift at RT-led multidisciplinary rounds. The data were collected through the EMR and placed into statistical run charts to be discussed at each multidisciplinary team meeting.
Results:
The results since 2016, when the project began, impacted our quality metrics by decreasing our chronic lung disease to 18% by 2018 below the national benchmark per VON. In 2020, we had 0 UEs per 100 ventilator days, 0 hospital-acquired pressure injuries per 1,000 CPAP days, and significantly decreased chronic lung disease in our patients. We have sustained these results and have standardized our methodologies and processes in how we treat our VLBW population.
Conclusions:
We approached this quality project as a multidisciplinary team, but it was led by passionate and dedicated RTs who truly made an impact on patient outcomes. Standardization of protocols, consistency in practice, and engagement of teams can lead to significant positive results.
CPAP Run Chart 2018 UPE events 2017-2021
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