Development of the NEC-Zero Toolkit: Supporting Reliable Implementation of Necrotizing Enterocolitis Prevention and Recognition

Abstract

The goal of the NEC-Zero project is to reduce the burden of necrotizing enterocolitis (NEC) by increasing access to evidence-based tools to help clinicians and parents integrate evidence into daily care. It involves (a) human milk feeding with prioritized mother's own milk; (b) use of a unit-adopted standardized feeding protocol; (c) a unit-adopted strategy for timely recognition that integrates risk awareness and a structured communication tool when symptoms develop; and (d) stewardship of empiric antibiotics and avoidance of antacids. A toolkit for caregivers and parents was developed to make implementation consistent. For clinicians the toolkit includes: the GutCheckNEC risk score, a structured communication tool, the “Avoiding NEC” checklist, and the NEC-Zero website. For parents, NEC-Zero tools include the website, three educational brochures in English and Spanish, and a collaborative care video produced with the NEC Society. This article describes the toolkit and how it has been accessed and used.

Exploring Internal Facilitators' Experience With NeoECHO to Foster NEC Prevention and Timely Recognition Through the iPARIHS Lens

“…NeoECHO was designed to offer quality improvement (QI) coaching, which may be less accessible to units with limited budgets and reduced participation in other QI collaboratives. In 2015, the NEC-Zero tool kit was developed to provide clinicians and parents with explanations of NEC, strategies to decrease the development of NEC, and supplemental NEC resources 7…”

“…5 In collaboration with parents, 6 we expanded the bundle to include parent education resources and created a tool kit for NEC prevention and timely recognition simpler to deliver. 7 The NEC-Zero bundle emphasizes the importance of human milk promotion, use of a standardized feeding protocol, medication stewardship (avoiding antacids and limiting empiric antibiotics), and NEC risk awareness using the GutCheck NEC risk score. Details about the GutCheck NEC risk score are available elsewhere, 8,9 and all tool kit items are freely available at the NEC-Zero Web site at https:// neczero.nursing.arizona.edu.…”

Neonatal Intensive Care Workflow Analysis Informing NEC-Zero Clinical Decision Support Design

“…The long-term goal of this program of research is to implement clinical decision support (CDS) tools to support consistent NEC prevention, NEC risk awareness, and timely recognition. 9 To be successful and useful to clinicians, tools need to fit the clinician's workflow in the NICU to avoid cognitive dissonance, minimize unintended consequences, and, ultimately, offer an advantage over the current ways of managing high-risk infants. In many settings, with the broad implementation of EHR systems, clinicians can be subjected to workflows that deliver misaligned, suboptimal experiences.…”

“…Although prevention evidence to reduce NEC occurrence is available and of low cost, 8 integrating prevention recommendations into clinical practice is not consistent, and tracking adherence is not simple. The long-term goal of this program of research is to implement clinical decision support (CDS) tools to support consistent NEC prevention, NEC risk awareness, and timely recognition 9 . To be successful and useful to clinicians, tools need to fit the clinician's workflow in the NICU to avoid cognitive dissonance, minimize unintended consequences, and, ultimately, offer an advantage over the current ways of managing high-risk infants.…”

Feasibility and Acceptability of a Neonatal Project ECHO (NeoECHO) as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis

“…To address a shortage of tools to support reliable NEC prevention practices, the NEC-Zero toolkit was developed. This toolkit included parent education brochures, an "Avoiding NEC" checklist, the GutCheck NEC risk score, a structured (i.e., SBAR) communication tool, parent videos, and a website (www.necze ro.nursi ng.arizo na.edu; Gephart et al, 2020).…”