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A Quality Improvement Project to Reduce Time to Full Enteral Feeds for Very Low Birth Weight Neonates
Abiola Olowoyeye1,2, Eric Basile3, Susan Kim4
1aDepartment of Neonatology, Phoenix Children's Hospital, Phoenix, Arizona.
Insights
Implementing a feeding schedule calculator significantly reduced the time to full enteral feeds for very low birth weight neonates. This quality improvement initiative in the NICU achieved faster feeding milestones without increasing adverse events.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Quality Improvement Science
Background:
- Standardized feeding guidelines aim to reduce morbidity in very low birth weight (VLBW) neonates.
- Adherence to protocols minimizes patient care variability.
- The study addresses low utilization of an existing feeding protocol.
Purpose of the Study:
- To reduce the time to full enteral feeds in VLBW neonates by 20% within 12 months.
- To improve feeding protocol adherence in a NICU setting.
- To monitor adverse events associated with feeding advancements.
Main Methods:
- A 12-month quality improvement project was conducted at a level IV regional perinatal center.
- A feeding schedule calculator, based on a standardized feeding protocol, was the key intervention.
- Education and implementation cycles were used, with monitoring of adverse events.
Main Results:
- Time to full enteral feeds (160 ml/kg/day) decreased from 24.7 to 17.7 days.
- Special-cause variation was observed on control charts, indicating process improvement.
- Mean central line duration reduced from 19 to 14.5 days.
Conclusions:
- A feeding volume calculator effectively reduced time to full enteral feeds in neonates.
- No increase in adverse events, such as necrotizing enterocolitis or poor weight gain, was observed.
- The intervention successfully improved feeding delivery efficiency in VLBW infants.
Background:
Adherence to standardized feeding guidelines has been proposed as a strategy to limit morbidity in very low birth weight neonates. Fostering adherence limits the variability in medicine that affects the quality of patient care. The aim of this study was to reduce by 20% the time to full enteral feeds in very low birth weight neonates in the NICU within a 12-month period.
Methods:
In a level IV regional perinatal center with low utilization of its feeding protocol, a 12-month quality improvement project was conducted with a key intervention of a feeding schedule calculator based on the unit standardized feeding protocol. Through studied education and implementation cycles, these feeding schedules were used to reduce time to full enteral feeds while monitoring adverse events related to their use.
Results:
During the course of this quality improvement project, our time to full enteral feeds of 160 ml/kg/day of feeds reduced from 24.7 days to 17.7 days after process changes with special-cause variation noted on control charts. We also showed a significant reduction in mean central line duration over the course of the project from a baseline of 19 days to 14.5 days.
Conclusion:
Through a key intervention of a feeding volume calculator, we were able to reduce the time to full enteral feeds in neonates without any increase in adverse events of necrotizing enterocolitis or poor weight gain.
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