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Published on: January 27, 2023
Quality Improvement Initiative in the NICU for Improved Practice of Cuff Blood Pressure Measurements
Nicole Cistone1, Danielle Erlenwein, Roopali Bapat
1The Ohio State University College of Nursing, Columbus (Ms Cistone); Nationwide Children's Hospital, Neonatal Network Columbus, Ohio (Messrs D Erlenwein, G. Ryshen, L. Thomas, R. Thomas, and N. Foor); and Department of Neonatology (Drs Bapat and Fathi), Nationwide Children's Hospital/The Ohio State University Wexner Medical Center, Columbus, OSU NICU Parent Advisor Nationwide Children's Hospital/The Ohio State University Wexner Medical Center, Columbus, Ohio. (Ms Haghnazari).
Insights
Reducing cuff blood pressure measurements in the neonatal intensive care unit (NICU) improved care for extremely preterm infants. This quality improvement initiative successfully decreased potentially painful stimuli for vulnerable newborns.
Area of Science:
- Neonatal intensive care
- Pediatric developmental outcomes
- Clinical quality improvement
Background:
- Extreme preterm infants experience prolonged hospitalizations and frequent painful stimuli.
- Routine care, such as cuff blood pressure (BP) measurements, may negatively impact neurodevelopmental outcomes.
- Cumulative exposure to noxious stimuli in the NICU is a concern for infant well-being.
Purpose of the Study:
- To assess the frequency of cuff BP measurements in hemodynamically stable extreme preterm infants.
- To implement strategies to reduce the number of cuff BP measurements in this population.
Main Methods:
- Utilized Institute for Healthcare Improvement quality improvement methodologies.
- Employed a multidisciplinary approach involving NICU staff.
- Collected data from infants born <27 weeks gestation using electronic medical records.
Main Results:
- Achieved a significant increase in adherence to the desired number of cuff BP measurements, from 5.0% at baseline to 63.2% post-intervention.
- Demonstrated successful implementation of a quality improvement project in a NICU setting.
Conclusions:
- Quality improvement methodologies can effectively enhance clinical care in the NICU.
- Reducing cuff BP measurements in stable extreme preterm infants is feasible and safe.
- Further research should explore reducing overall painful stimuli and correlating these interventions with long-term developmental outcomes.
Background:
Extreme preterm infants face lengthy hospitalizations and are often subjected to painful stimuli. These stimuli may be related to routine caregiving that may negatively impact long-term developmental outcomes. Frequently obtained cuff blood pressure (BP) measurements are an example of a potentially noxious stimulus to preterm infants that may have a cumulating impact on development.
Purpose:
The primary aim was to explore the frequency of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the neonatal intensive care unit (NICU). Our secondary aim was to reduce the number of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the NICU.
Methods:
Quality improvement methodologies per the Institute for Healthcare Improvement were used combined with a multidisciplinary approach. Participants were infants born less than 27 weeks of gestation and discharged home. The baseline period was 2015 through Q2-2018 and the intervention period was Q3-2018 through Q1-2020. The electronic medical record was used to collect data and Minitab Statistical Software was used for data analysis.
Findings/Results:
A baseline of 5.0% of eligible patients received the desired number of cuff BP measurements and increased to 63.2% after the intervention period.
Implications For Practice:
Findings demonstrate that using quality improvement methodology can improve clinical care. Findings suggest the feasibility and safety of reducing the number of cuff BP measurements obtained on hemodynamically stable infants in the NICU.
Implications For Research:
Future endeavors should aim to reduce the quantity of painful stimuli in the NICU. Long-term developmental outcomes should be correlated in these patients.
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