Care Bundle to Improve Oxygen Maintenance and Events.

Area of Science:

• Neonatal Intensive Care
• Pediatric Pulmonology
• Quality Improvement Science

Background:

• Prolonged deviations from target oxygen saturation (SpO2) and frequent desaturation events in preterm infants increase risks for retinopathy of prematurity (ROP) and long-term neurodevelopmental impairment.
• Effective SpO2 management is critical for improving outcomes in vulnerable preterm infants.

Purpose of the Study:

• To implement a care bundle aimed at increasing the mean time spent within the target SpO2 range (WTR) by 10%.
• To decrease the frequency of desaturation events by 5 events per patient day within 18 months.

Main Methods:

• A quality improvement initiative was conducted in a 46-bed neonatal intensive care unit (NICU) involving 246 staff members.
• Interventions included new practice guidelines, daily SpO2 summaries, infant wellness assessments, standardized workflows, and improved SpO2 alarm response.
• Data collected included staff satisfaction, compliance, resource use, and morbidity/mortality rates.

Main Results:

• Mean time WTR increased from 65.3% to 75.3%.
• Frequency of desaturation events decreased from 25.1 to 16.5 events per patient day.
• Postimplementation, duration of high-frequency ventilation and supplemental oxygen decreased; morbidity and mortality rates remained similar. Staff satisfaction was high across interventions.

Conclusions:

• Implementation of a care bundle effectively improved oxygen saturation maintenance in preterm infants.
• The care bundle significantly increased time within the target SpO2 range and reduced desaturation events, contributing to better infant care.