Related Experiment Video
Updated: Dec 30, 2025
Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
Published on: July 14, 2023
Reducing Variation in the Management of Apnea of Prematurity in the Intensive Care Nursery
Katherine Coughlin1, Michael Posencheg2, Lauren Orfe2
1Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Penn Neonatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania katherinealison@gmail.com.
Insights
Standardizing discharge criteria for premature infants with apnea of prematurity reduced observation time variability. This quality improvement initiative improved documentation and staff satisfaction without increasing length of stay.
Area of Science:
- Neonatal Medicine
- Quality Improvement Science
- Pediatric Critical Care
Background:
- Apnea of prematurity causes bradycardia/desaturation events in premature infants.
- Discharge observation periods in Intensive Care Nurseries were variable, despite guidelines.
- A standardization initiative was implemented for infants born <36 weeks' gestation.
Purpose of the Study:
- To standardize the time to discharge after the last documented apnea event.
- To reduce variability in the observation period for premature infants.
Main Methods:
- Quality improvement methods, including Plan-Do-Study-Act cycles.
- Standardized definitions for events and discharge criteria were established.
- Statistical process control was used to monitor outcomes.
Main Results:
- The mean observation period after the last event narrowed from 3.6 to 4.8 days.
- Completeness of event documentation increased from 38% to 63%.
- Documentation of significant events rose from 38% to 88%, with unchanged length of stay.
Conclusions:
- Decreased variation in managing apnea of prematurity was achieved.
- Staff satisfaction improved alongside standardized care.
- Future steps include EMR flowsheet revision and network spread.
Background:
Premature infants have bradycardia and/or desaturation events due to apnea of prematurity that resolve as the infants mature. Despite American Academy of Pediatrics guidelines recommending a standard "event-free" period before discharge, length of observation in our Intensive Care Nursery was variable. By June 2018, for infants born <36 weeks' gestation in the Intensive Care Nursery, we aimed to standardize time to discharge after the last documented event at 5 days, when the baseline mean was 3.6 days (range 0-6 days).
Methods:
A quality-improvement team used the Model for Improvement. Plan-do-study-act cycles improved nursing documentation of events and standardized discharge criteria after consensus on operational definitions. The outcome measure was days to discharge after last documented event. Process measures included percentage of events documented completely and correctly in the electronic medical record. Balancing measure was length of stay after 36 weeks' corrected gestational age. We used statistical process control.
Results:
The baseline event watch ranged from 0 to 6 days. After defining significant events, documentation expectations, and consensus on a 5-day "watch" before discharge, the event watch range narrowed with a mean that shifted from 3.6 to 4.8 days on X-bar S statistical process control chart. Completeness of documentation increased from 38% to 63%, and documentation of significant events increased from 38% to 88%. Length of stay after 36 weeks' corrected gestational age was unchanged, and nursing satisfaction improved.
Conclusions:
We found decreasing variation in the management of apnea of prematurity while simultaneously improving staff satisfaction. Next steps include revising electronic medical record flowsheets and spread to network NICUs.
Related Concept Videos
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....