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Quality Improvement Project to Improve Adherence to Best Practices to Decrease Incidence of Necrotizing Enterocolitis
Ahreen Allana1,2, Sidra Bashir1,2, Ivan Hand1,2
1Department of Pediatrics, NYC Health & Hospitals/Kings County, Brooklyn, NY 11203, USA.
Insights
Implementing evidence-based practices significantly reduced necrotizing enterocolitis (NEC) incidence in preterm infants. This quality improvement project enhanced care bundles, leading to a substantial decrease in NEC cases within the neonatal intensive care unit (NICU).
Area of Science:
- Neonatology
- Pediatric Surgery
- Quality Improvement Science
Background:
- Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency affecting preterm infants.
- High incidence rates necessitate improved preventative strategies in neonatal intensive care units (NICUs).
Purpose of the Study:
- To enhance the adoption of evidence-based practices for NEC prevention.
- To decrease the incidence of NEC in a level III NICU through a quality improvement initiative.
Main Methods:
- Implementation of a nine-item evidence-based practice bundle for NEC prevention.
- Utilized two Plan-Do-Study-Act (PDSA) cycles over two years to refine interventions.
- Monitored adherence to process measures and NEC incidence in infants <1500g or <32 weeks gestation.
Main Results:
- Adherence to care bundles improved from 78% to 91.6% (p < 0.05).
- NEC incidence reduced by 24% after the first PDSA cycle (7% to 5.3%).
- Further reduction to 2.8% (60% from baseline) after the second PDSA cycle, though not statistically significant due to sample size.
Conclusions:
- Quality improvement initiatives can significantly increase adherence to evidence-based practices for NEC prevention.
- The implemented bundle demonstrated a notable reduction in NEC incidence in preterm infants.
- Sustained efforts in QI are crucial for managing and reducing NEC in high-risk infant populations.
Abstract:
Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC in our level III NICU. Methods: Our QI team implemented a bundle of nine of these evidenced-based practices for NEC prevention and disseminated information among the NICU team. Items in the bundle included delayed cord clamping, parental education on the importance of breast milk, obtaining early consent for donor breast milk, adherence to the unit's feeding protocol, avoiding routine gastric residual checks, the discontinuation of antibiotics at 48 h once blood cultures were negative, restricting the use of antacids, nasogastric tube (NGT) replacement every 72 h and the removal of central lines once a feeding volume of 100 mL/kg/day was attained. The baseline incidence of clinically proven NEC was found to be 7% at the start of the intervention. We conducted two Plan-Do-Study-Act (PDSA) cycles over a 2-year period from 1 January 2021 to 31 December 2022. Results: There were 74 infants who met the inclusion criteria of being <1500 g and/or at <32 weeks of gestation. The adherence to our process measures improved over the course of our two PDSA cycles from 78% adherence to 91.6%, p < 0.05. The incidence of NEC decreased from 7% to 5.3% following the first PDSA cycle, a 24% reduction. Following the second PDSA cycle, the incidence decreased even further from 5.3% to 2.8%, a 60% reduction from baseline, although this was not statistically significant due to the small sample size. Conclusions: In this QI initiative, we achieved improved adherence to several evidence-based interventions over a two-year period with the aim of reducing the incidence of NEC at our institution.
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