Quality Improvement Initiative to Increase the Use of Nasogastric Hydration in Infants With Bronchiolitis

Abstract

We successfully increased the rates of NG hydration in eligible children with bronchiolitis by using educational and system-based interventions.

Nasogastric Hydration for Bronchiolitis: Sustaining Change in Practice

“…Rates of NG hydration during the sustainment phase (62%) were not significantly different ( P = .74) than rates of hydration during the preceding QI initiative (58%). 2 The monthly rate of NG hydration during the sustainment phase was stable with no special cause variation detected during the study period ( Figure 2 ). There were no significant differences in gender, RSV infection rates, presenting history or exam, any oxygen requirement (by nasal cannula or face mask) at time of admission, hospital course, length of stay, or discharge diagnosis between the patients who received NG versus IV hydration ( Table 1 ).…”

“…Chart review of patients admitted with bronchiolitis was performed to determine rates of NG hydration and identify complications as per methodology described previously. 2 Our inpatient clinical database (KIDDOS) was queried to identify children 1 to 23 months old admitted with a diagnosis (International Classification of Diseases, Tenth Revision [ICD-10]) of acute bronchiolitis (J21.9, J21.0, J21.1, J21.8, J20.9, J11.1), respiratory distress (J80, R06.00), wheezing (R06.2, J98.8), respiratory syncytial virus (RSV)-related infections (B97.4, J12.1, J20.5, B97.4, J02.9), and viral pneumonia (J12.9, J12.89). Chart review data were entered into REDCap (Research Electronic Data Capture), a secure web-based data capture application hosted at Washington University in St Louis.…”

“…Physicians chose IV or NG hydration at the time of presentation using their clinical discretion, personal preference, and education received during the implementation phase of the QI initiative. 2 Criteria used during retrospective chart review that define children not eligible for NG hydration are shown in Figure 1 . Balancing measures were complications such as aspiration, epistaxis, accidental placement of NG tube in airway, or worsening of disease severity that could be potentially attributed to NG hydration.…”

“… 1 We implemented a QI initiative to increase the rate of nasogastric (NG) hydration in children with bronchiolitis from January to April 2016. 2 The rationale for the initiative was that NG hydration, compared with intravenous (IV) hydration, can provide better nutrition since breast milk or formula can be given via NG tube. Decreased nutritional intake early in the hospital course has been associated with a longer length of stay in infants with bronchiolitis.…”

“… 5 Our initiative was successful in increasing rates of NG hydration in eligible children from 0% to 58% in 6 months. 2 We sought to determine if this change could be sustained without further interventions.…”