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Published on: January 27, 2023
Targeting discrepancies in linear growth measurements in the neonatal intensive care unit through nursing
Gail Snyder1, Rebekah Wilkinson2, Raina Evans2
1Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Insights
Accurate infant length measurements are crucial for growth monitoring. This quality improvement study enhanced measurement precision and length board availability in a neonatal intensive care unit.
Area of Science:
- Neonatal intensive care
- Pediatric growth monitoring
- Quality improvement in healthcare
Background:
- Accurate infant length measurement is vital for identifying growth deficiencies and guiding nutritional adjustments.
- The gold standard involves using a length board with two clinicians for precise assessment.
- Variability in measurement accuracy can impact clinical decision-making.
Purpose of the Study:
- To improve the accuracy of infant length measurements, defined as a discrepancy of ≤1 cm between nurse and audit assessments.
- To increase and maintain the availability of length boards within the neonatal intensive care unit.
Main Methods:
- A quality improvement study utilizing a before-and-after design with two Plan-Do-Study-Act (PDSA) cycles and a sustainability cycle.
- Blinded audits were conducted within 48 hours of bedside nurse measurements to record discrepancies.
- Chi-squared testing was used to analyze the significance of measurement differences.
Main Results:
- Significant improvement in measurement accuracy was observed, with discrepancies ≤1 cm increasing from 38% pre-intervention to 74% post-PDSA #2 (p=0.003) and 71% in the sustainability cycle (p=0.007).
- Consistent length percentiles between nurse and audit measures improved by 32% post-PDSA #2 (p=0.012).
- Length board availability increased, and nursing surveys indicated improved perceived ease of use and reduced knowledge gaps.
Conclusions:
- The intervention successfully improved the precision of linear measurements and length board utilization in the neonatal intensive care unit.
- Future efforts will focus on further increasing length board availability and implementing ongoing educational programs.
- Enhanced measurement accuracy supports better clinical assessments and patient care.
Objective:
Accurate length measurements are essential for infants to identify growth deficiencies and adjust nutrition accordingly. The gold standard for length measurement in infants is using a length board with two people to obtain an accurate clinical assessment. We aimed to improve the number of measurements with the desired minimal difference, defined as a discrepancy ≤1 cm between nurse and audit measurements, in our center. Our secondary aim was to increase and maintain the number of length boards available.
Methods:
This quality improvement (QI) study used a before-and-after intervention comparison design in a single-level IV neonatal intensive care unit between June 2023 and December 2023, completing two Plan-Do-Study-Act (PDSA) cycles and one sustainability cycle that targeted nursing interventions. Blinded audits were performed by the QI team < 48 h after bedside nurse measurement and discrepancies between measurements were recorded. Chi-squared testing determined the significance between measurement discrepancies at each time point.
Results:
The QI team measured 34 infants at each time point for 136 total measurements. There was a significant improvement in the desired minimal difference between the pre-intervention and post-PDSA #2 groups (38% vs 74%, p = 0.003) and between the pre-intervention and sustainability cycle groups (38% vs 71%, p = 0.007). There was no significant difference between PDSA #2 and our sustainability cycle. There was a 32% improvement among infants with consistent length percentiles between nurse and audit measures after PDSA #2 (42% vs 74%, p = 0.012). The number of length boards was increased during the study. Anonymous nursing surveys revealed an improvement in the perceived ease of use of length boards (51-71%) and minimized knowledge gaps.
Conclusions:
During the time of our intervention, there was an improvement in the precision of linear measurements and length board usage. Future PDSA cycles will focus on increasing the availability of length boards and establishing continued length board education.
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