A Quality Improvement Approach to Optimizing Medication Use in the Neonatal Intensive Care Unit

Ellsbury, Dan L.; Ursprung, Robert

doi:10.1016/j.clp.2011.12.001

Cited by 14 publications

(9 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our goal was to develop and implement QI initiatives to reduce the incidence of NEC in VLBW infants while monitoring infant growth and side effects of interventions (Table 1). 35, 36 The team consisted of the neonatologist team leader, NICU medical director, two NICU dieticians, one advanced practice nurse (APN), NICU clinical nurse coordinator, and the director of NICU lactation services.…”

Section: Methodsmentioning

confidence: 99%

Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods

et al. 2014

View full text Add to dashboard Cite

Objective Due to a rise in necrotizing enterocolitis (NEC, stage ≥2) among very low birth weight (VLBW, birth weight <1500g) infants from 4% in 2005-6 to 10% in 2007-8, we developed and implemented quality improvement (QI) initiatives. The objective was to evaluate the impact of QI initiatives on NEC incidence in VLBW infants. Study Design In September 2009 we developed a NEC QI multidisciplinary team that conducted literature reviews and reviewed practices from other institutions to develop a feeding protocol, which was implemented in December 2009. The team tracked intervention compliance and occurrence of NEC stage ≥2. In May 2010 we reviewed our nasogastric tube practice and relevant literature to develop a second intervention that reduced nasogastric tube indwelling time. The infants were divided into three groups: baseline (Jan 2008-Nov 2009, n219), QI phase 1 (Dec 2009-May 2010, n62), and QI phase 2 (June 2010-Nov 2011, n170). Result The NEC incidence did not decrease after implementation of the feeding protocol in QI phase 1 (19.4%), but did decline significantly after changing nasogastric tube management in QI phase 2 (2.9%). Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC. Conclusion QI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU. Nasogastric tube bacterial contamination may have contributed to our peak in NEC incidence.

show abstract

Section: Methodsmentioning

confidence: 99%

Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Workshops included small group exercises that provided opportunity to apply QI methods to specific clinical problems and emphasized shared problem solving with clinicians from diverse backgrounds. 27,28 QI project presentations were a major feature of the program, and were used to show multiple approaches to clinical problems and to create a setting that highlighted the work of high-performing NICUs. To remove barriers to participation and to emphasize the organization's commitment to improving patient care, funding for travel and meeting costs was provided by PDX with the expectation that participants would take the acquired skills back to their practices and apply them within their own NICU's QI infrastructure.…”

Section: Qi Culturementioning

confidence: 99%

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Ellsbury¹,

Clark²,

Ursprung³

et al. 2016

Pediatrics

Self Cite

113

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVE: Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the “100,000 Babies Campaign.” METHODS: Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record–based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. RESULTS: From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks’ gestation) improved. CONCLUSIONS: Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record–based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes.

show abstract

“…This applies to routine surveillance and sentinel sites, albeit in different ways. The neonatal quality improvement literature provides some useful lessons [90][91][92].…”

Section: Impact On Process and Culturementioning

confidence: 99%

Adverse drug reactions in neonates: could we be documenting more?

Hawcutt

O’Connor

Turner

2014

Expert Review of Clinical Pharmacology

View full text Add to dashboard Cite

Neonates are vulnerable to adverse drug reactions but reports of these events are relatively infrequent. Reporting can be increased by adapting a number of standard techniques to the unique features of neonatal care and pathology. However, clinicians and parents will be reluctant to report information about harms in the absence of mechanisms to ensure that reports affect clinical practice. Improved reporting will depend on education and cultural change that are informed by research about pharmacovigilance in neonatal settings. The efficient use of neonatal adverse drug reaction reports will require harmonization of terminology and interoperable databases.

show abstract

A Quality Improvement Approach to Optimizing Medication Use in the Neonatal Intensive Care Unit

Cited by 14 publications

References 59 publications

Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods

Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Adverse drug reactions in neonates: could we be documenting more?

Contact Info

Product

Resources

About