Care Bundle to Improve Oxygen Maintenance and Events
Sandesh Shivananda1, Sumesh Thomas2, Sourabh Dutta3,4
1Division of Neonatology, BC Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
A new care bundle improved oxygen saturation (SpO2) management in preterm infants, increasing time within the target range and reducing dangerous desaturation events. This intervention helps prevent retinopathy of prematurity (ROP) and neurodevelopmental issues.
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.
Abstract:
Prolonged periods spent outside the target range of oxygen saturation (SpO2) in preterm infants, along with frequent desaturation events, predispose them to retinopathy of prematurity (ROP) and long-term neurodevelopmental impairment. The primary aim of this study was to increase the mean time spent within the target SpO2 range (WTR) by 10% and to reduce the frequency of desaturation events by 5 events per patient day, respectively, within 18 months of implementing a care bundle.
Methods:
This study was completed in a 46-bed neonatal intensive care unit (NICU), involving 246 staff members and led by a quality improvement team. The change interventions included implementing new practice guidelines, reviewing daily summaries of SpO2 maintenance, daily infant wellness assessment, standardizing workflow, and responding to SpO2 alarms. In addition, we collected staff satisfaction and compliance with change interventions, resource use, and morbidity and mortality data at discharge.
Results:
The mean time spent WTR increased from 65.3% to 75.3%, and the frequency of desaturation events decreased from 25.1 to 16.5 events per patient day, respectively, with a higher magnitude of benefit in infants on days with supplemental oxygen. Postimplementation, the duration of high-frequency ventilation and supplemental oxygen were lower, but morbidity and mortality rates were similar. Staff satisfaction with training workshops, coaching, use of the infant wellness assessment tool, and SpO2 alarm management algorithms were 74%, 82%, 80%, and 74%, respectively.
Conclusion:
Implementing a care bundle to improve oxygen maintenance and reduce desaturation events increased the time spent WTR and reduced the frequency of desaturation events.
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