scholarly journals Improving Communication Between Health Care Professionals and Parents: A Quality Improvement Initiative

2017 ◽  
Vol 4 (1) ◽  
pp. 1-9
Author(s):  
Poonam Joshi ◽  
Meena Joshi ◽  
Aakansha Sharma ◽  
Anu Sachdeva ◽  
Rajesh Sagar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Care Professionals ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Parental Satisfaction ◽  
Satisfaction Score ◽  
Quality Improvement Initiative ◽  
Base Line ◽  
Team Members ◽  
Sick Neonate

This quality improvement initiative was undertaken in a tertiary care neonatal intensive care unit (NICU) to improve communication between the HCP and parents related to the sick neonates admitted in NICU as measured by increase in parental satisfaction score from base line (34.5%) to 80% in 3 months time. A team was formulated to evaluate the reasons for low parental satisfaction resulting from communication between HCP and the parents of sick neonates and to further plan strategies for improving the same. Multiple PDSA cycles were implemented. The results of the all PDSA cycles were discussed amongst team members. Satisfaction of parents related to communication with HCP increased to more than 80% in 3 months time followed by increase up to 90% in sustenance phase. Multiple simple feasible interventions led to improvement in communication between the HCP and parents as evident by increase in satisfaction score (40.8 ± 4.3 vs. 40.8 ± 4.3 vs. 91.3 ± 4.8, p < 0.001). There was significant improvement in the satisfaction scores of the mothers on communication related to sick neonate in NICU at the end of intervention phase as well as in the sustenance phase. Multiple simple doable and feasible interventions had led to the improvement in communication between the HCP and parents hence improving the satisfaction of parents related to their communication with HCP.

scholarly journals Quality improvement initiative approach to decrease the unindicated usage of antibiotics in a neonatal intensive care unit of a tertiary care teaching hospital in Hyderabad, India

2021 ◽  
Vol 10 (Suppl 1) ◽  
pp. e001474
Author(s):  
Kalyan Chakravarthy Konda ◽  
Himabindu Singh ◽  
Alimelu Madireddy ◽  
Megha Mala Rao Poodari
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Antimicrobial Resistance ◽  
Neonatal Intensive Care Unit ◽  
Antibiotic Stewardship ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Quality Improvement Initiative ◽  
Antibiotic Lock

Antimicrobial resistance is an emerging global problem concerned with patient safety. It is even more challenging in developing countries like India. Antibiotic stewardship initiative is the best arrow in the quiver to prevent and control this antimicrobial resistance. We observed 61% of the neonates admitted to neonatal intensive care unit of Niloufer hospital, Hyderabad, India were receiving improper antibiotics with respect to choice of drug or dosage or duration. Subsequently, an antibiotic stewardship team was formed to address the antibiotic misuse. Team consisted of neonatology faculty, residents, staff nurses, infection control nurses and microbiologist. We identified problems related to staff awareness, policy issues like lack of display of the antibiotic policy and lack of antibiotic lock, process issues like low rate of documentation of indication for initiation or escalation of antibiotic and a lack of dynamic review plan regarding continuation or de-escalation. We used the Plan-Do-Study-Act cycles to test and adapt solutions to these problems. Within 10 weeks of starting our quality improvement (QI) project, the proportion of unindicated antibiotic usage decreased from 61% to 27%. Timely de-escalation of antibiotic is a neglected intervention in neonates, and yielded the maximum result in our study. We conclude that QI projects are simple, doable yet powerful effective tools to address the burning problems like antibiotic misuse. This result was very satisfying and encouraging boosting our team’s faith in the effectiveness of QI approach.

CLABSI reduction using evidence based interventions and nurse empowerment: a quality improvement initiative from a tertiary care NICU in Pakistan

2020 ◽  
pp. archdischild-2019-318779
Author(s):  
Ali Shabbir Hussain ◽  
Anjum Mohyuddin Ahmed ◽  
Saba Arbab ◽  
Shabina Ariff ◽  
Rehan Ali ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Central Line ◽  
University Hospital ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Post Intervention ◽  
Nurse Empowerment

ObjectiveCentral line associated bloodstream infection (CLABSI) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). We designed a CLABSI Prevention Package (CPP) to decrease NICU CLABSI rates, using evidence-proven interventions.DesignThis was a quality improvement (QI) project. Data collection was divided into three phases (pre-implementation, implementation and post implementation). SQUIRE2.0 guidelines were used to design, implement and report this QI initiative.SettingA tertiary care level 3 NICU at the Aga Khan University Hospital (AKUH), Karachi, Pakistan.PatientsAll patients admitted to the AKUH NICU from 1 January 2016 to 31 March 2018 who had a central line in place during their NICU admission.InterventionsCPP used evidence-based interventions focusing on hand hygiene, aseptic central line insertion techniques and central line care, prevention of fungal infections and nurse empowerment.Main outcome measuresCLABSI rates pre and post intervention were recorded. Secondary outcomes were risk factors for CLABSI, device (central line) utilisation ratio, CLABSI related mortality and micro-organism profile.ResultsCLABSI rates decreased from 17.1/1000 device days to 5.0/1000 device days (relative risk (RR)=0.36, CI=0.17–0.74). Device (central line) utilisation ratio declined from 0.30 to 0.25. Out of 613 patients enrolled in our study, 139 (22.7%) died. Mortality was higher in CLABSI group (n=20, 44%) as compared with non CLABSI group (n=119, 21.1%) (p<0.001). Gestational age of <27 weeks was an independent risk factor for CLABSI (RR=4.45, CI=1.10–18.25, p=0.03). A total of 158 pathogens were isolated among which 68 were associated with CLABSI. Gram-negative bacteria 31 (47.7%) were the most common cause of CLABSI. Ninety-seven (61%) micro-organisms were multi-drug resistant.ConclusionsCPP was effective in decreasing NICU CLABSI rates and can be used as a model to decrease NICU CLABSI rates in low or middle-income countries.

Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country

2021 ◽  
pp. archdischild-2021-321552
Author(s):  
Gul Ambreen ◽  
Vikram Kumar ◽  
Syed Rehan Ali ◽  
Uswa Jiwani ◽  
Waqar Khowaja ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Weight Gain ◽  
Parenteral Nutrition ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Rate Of Change ◽  
Preterm Neonates ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Z Scores

ObjectiveNutrition societies recommend using standardised parenteral nutrition (SPN) solutions. We designed evidence-based SPN formulations for neonates admitted to our neonatal intensive care unit (NICU) and evaluated their outcomes.DesignThis was a quality improvement initiative. Data were collected retrospectively before and after the intervention.SettingA tertiary-care level 3 NICU at the Aga Khan University in Karachi, Pakistan.PatientsAll NICU patients who received individualised PN (IPN) from December 2016 to August 2017 and SPN from October 2017 to June 2018.InterventionsA team of neonatologists and nutrition pharmacists collaborated to design two evidence-based SPN solutions for preterm neonates admitted to the NICU.Main outcome measuresWe recorded mean weight gain velocity from days 7 to 14 of life. The other outcomes were change in weight expressed as z-scores, metabolic abnormalities, PN-associated liver disease (PNALD), length of NICU stay and episodes of sepsis during hospital stay.ResultsNeonates on SPN had greater rate of change in weight compared with IPN (β=13.40, 95% CI: 12.02 to 14.79) and a smaller decrease in z-scores (p<0.001). Neonates in the SPN group had fewer hyperglycemic episodes (IPN: 37.5%, SPN: 6.2%) (p<0.001), electrolyte abnormalities (IPN: 56.3%, SPN: 21%) (p<0.001), PNALD (IPN: 52.5%, SPN: 18.5%) (p<0.001) and sepsis (IPN: 26%, SPN: 20%) (p<0.05). The median length of stay in NICU was 14.0 (IQR 12.0–21.0) for the IPN and 8.0 (IQR 5.0–13.0) days for the SPN group.ConclusionsWe found that SPN was associated with shorter NICU stay and greater weight gain. In-house preparation of SPN can be used to address the nutritional needs in resource-limited settings where commercially prepared SPN is not available.

Development of Potentially Better Practices for the Neonatal Intensive Care Unit as a Culture of Collaboration: Communication, Accountability, Respect, and Empowerment

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e471-e481
Author(s):  
Judy Ohlinger ◽  
Mark S. Brown ◽  
Sue Laudert ◽  
Sue Swanson ◽  
Ona Fofah ◽  
...  
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Care Quality ◽  
Care Group ◽  
Team Members ◽  
Leadership Management ◽  
Standards Of Conduct ◽  
Year 2000 ◽  
Multidisciplinary Teamwork

Objective. The Vermont Oxford Network (VON) CARE Group was formed in response to the need to create organizational cultures supportive of change and quality improvement. Methods. The CARE Group consisted of team members from 4 participating neonatal intensive care units (NICUs). All CARE Group members chose to work on multidisciplinary teamwork for the duration of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000. A questionnaire was developed by the CARE Group and administered to the 4 focus group NICUs. The survey focused on 6 domains of the organization: unit coordination, working in the NICU, leadership, management of disagreements, authority, and unit culture. Benchmarking visits were completed to supplement the information found in the survey and the literature. Results. Seven potentially better practices (PBPs) were developed on the basis of the surveys, benchmark visits, and literature reviews. The PBPs include 1) a clear, shared NICU purpose, goals, and values; 2) effective communication among and between teams and team members; 3) leaders lead by example; 4) nurture a collaborative NICU environment with trust and respect; 5) live principled standards of conduct and standards of excellence; 6) nurture competent and committed teams and team members; and 7) commit to effective and positive conflict management. Conclusions. The CARE Group successfully used quality improvement methods and collaboration to delineate principles and practices of multidisciplinary teamwork.

A Quality Improvement Initiative to Provide Timely Central Vascular Access in a Neonatal Intensive Care Unit

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kimberly Kristoff ◽  
Rui Wang ◽  
David Munson ◽  
Kevin Dysart ◽  
Stracuzzi Lauren ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Vascular Access ◽  
Neonatal Intensive Care ◽  
Quality Improvement Initiative

Improving Hydroxychloroquine Dosing and Toxicity Screening at a Tertiary Care Ambulatory Center: A Quality Improvement Initiative

2020 ◽  
Vol 48 (1) ◽  
pp. 138-144
Author(s):  
Sahil Koppikar ◽  
Stephanie Gottheil ◽  
Chandra Farrer ◽  
Natasha Gakhal
Keyword(s):  
Quality Improvement ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Retinal Toxicity ◽  
Force Function ◽  
Quality Improvement Initiative ◽  
Toxicity Screening ◽  
Number Of Patients ◽  
Retinal Screening ◽  
Retinopathy Screening

Objective.Hydroxychloroquine (HCQ) is a commonly used weight-based medication with a risk of retinal toxicity when prescribed at doses above 5 mg/kg/day. The objectives of our study were (1) to characterize the frequency of inappropriate HCQ dosing and retinopathy screening, and (2) to improve guideline-based management by implementing quality improvement (QI) strategies.Methods.A retrospective chart review was performed to obtain baseline analysis of HCQ dosing, weight documentation, and retinal toxicity screening to characterize current practices. The primary aim was to increase the percentage of patients appropriately dosed from 30% to 90% over a 10-month period. The secondary aim was to increase the percentage of documented retinal screening from 59% to 90%. The process measure was the number of patients with a documented weight in the chart. The balancing measure was the physician’s perceived increase in time spent with each patient due to implemented interventions. QI methodology was used to implement sequential change ideas: (1) HCQ weight-based dosing charts to facilitate prescription regimens; (2) addition of scales to patient rooms to facilitate weight documentation; and (3) electronic medical record (EMR) “force function” involving weight documentation and autodosing prescription.Results.The percentage of patients being weighed increased from 40% to 92% after 10 months. Appropriate HCQ dosing improved from 30% to 89%. Retinal screening documentation improved by 33%.Conclusion.Dosing charts in clinic rooms, addition of weight scales, and EMR force function autodosing prescriptions significantly improved appropriate HCQ dosing practices. These interventions are generalizable and can promote safe and guideline-based care.

scholarly journals Perinatal quality improvement bundle to decrease hypothermia in extremely low birthweight infants with birth weight less than 1000 g: single-center experience over 6 years

2020 ◽  
Vol 68 (7) ◽  
pp. 1256-1260
Author(s):  
Dilip R Bhatt ◽  
Nirupa Reddy ◽  
Reynaldo Ruiz ◽  
Darla V Bustos ◽  
Torria Peacock ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Birth Weight ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Hospital Costs ◽  
Moderate Hypothermia ◽  
Quality Improvement Initiative ◽  
Single Center Experience ◽  
Continuous Quality ◽  
Extremely Low Birthweight

Normothermia (36.5°C–37. 5°C) at the time of admission to the neonatal intensive care unit (NICU) in extremely low birthweight (ELBW) infants (birth weight <1000 g) is associated with decreased morbidity and mortality, decreased length of stay and hospital costs. We designed a thermoregulation bundle to decrease hypothermia (<36.5°C) in ELBW infants with a multidisciplinary perinatal quality improvement initiative that included the following key interventions: dedicated delivery room (DR)/operating room (OR) for all preterm deliveries of ≤32 weeks with DR/OR temperature set 24/7 at 74°F by the hospital engineering staff, use of exothermic mattress, preheated radiant warmer set at 100% for heat prior to delivery, servo-controlled mode after the neonate is placed on the warmer, and use of plastic wrap, head cap and warm towels. A total of 200 ELBW infants were admitted to our NICU between January 1, 2014 and December 31, 2019. Hypothermia (<36.5°C) occurred in 2.5% of infants, normothermia (36.5°C–37.5°C) in 91% of infants and transitional hyperthermia (>37.5°C) in 6.5% of ELBW infants. No case of moderate hypothermia (32°C–36°C) was seen in our infants. Our target rate of less than 10% hypothermia was reached in ELBW infants over the last 2 years with no cases of moderate hypothermia in 6 years. Eliminating hypothermia among ELBW remains a challenge and requires team effort and continuous quality improvement efforts.

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