Preclinical research is essential to the elucidation of the mechanisms of disease. Clinical and translational research take a vital step towards the patient. However, Quality Improvement initiatives are where new information and evidence are brought to the bedside. While controlled clinical trials are the gold standard of proof, they are time-consuming and require years of study before patients can reap their benefits. Systematic quality improvement initiatives, on the other hand, allow clinicians to implement evidence-based innovations in a manner that allows us to assess their efficacy in the NICU.
Benchmarking is where the process begins. MANA clinicians monitor an array of clinical practices and outcomes in order to identify trends, positive and negative. In addition, we contribute data to the CDC and the Vermont Oxford Network (VON). The latter is a collaborative database that collects and analyzes an assortment of outcomes from very low birth weight infants (<1500 grams at birth) born all over the United States.
In conjunction with our colleagues in nursing and the allied health professions, MANA physicians are carrying out an assortment of rigorous QI initiatives.
- Reducing the Incidence of Chronic Lung Disease: An intensive, multidisciplinary series of interventions has resulted in a dramatic reduction in the incidence of CLD, down to levels far below regional and national benchmarks.
- Targeted Oxygen Saturation to Reduce Severe ROP: Rigorous control of oxygen administration along with tighter limits on oxygenation levels in premature infants has resulted in an extraordinary reduction in the incidence of severe ROP.
- Preventing Nosocomial Infection: An evidence-based protocol for the insertion and management of PICC lines has resulted in remarkably low rates of nosocomial infection in very low birth weight infants.
- Decreasing Unplanned Extubation: In an effort to reduce the rate of unplanned extubation, MANA clinicians have implemented a coordinated series of interventions by physicians, nurses respiratory therapists and advanced neonatal practitioners. Unplanned extubations are monitored continuously.
- NICU Pharmacy Initiatives: Medication errors in the hospital are the subject of intense scrutiny. We have taken a number steps to enhance patient safety in the high intensity world of the NICU.
- Adoption of a MANA-annotated Neofax as the standard drug reference in the NICU
- Introduction of a NICU satellite pharmacy to reduce medication errors
- Computerized orders for continuous medication infusion and parenteral alimentation
- Medical Informatics: A customized computerized NICU notes program allows us to track care and outcomes.
- NICU OR Initiative: A multidisciplinary committee of neonatologists, nurses, anesthesiologists and surgeons works to establish standards of intraoperative care and to ensure the safe, efficient performance of surgery in the NICU for the most critically ill neonates.
- NICU Discharge: Our focus on family-centered care has led to the development of a coordinated, multidisciplinary effort to ensure that babies are discharged from the NICU as quickly as possible and that their parents have been well prepared during their infant’s hospital stay.
- Increasing the Rate of Breastfeeding in the NICU: A multidisciplinary team of neonatologists, neonatal practitioners, nurses and lactation consultants are working with obstetricians in the community and with labor and delivery nurses to promote the decision to breast feed, even before the baby is born. Progress is monitored continuously by data collection at the bedside.