Less Invasive Surfactant Administration: A Quality Improvement Project.

Area of Science:

• Neonatal Medicine
• Quality Improvement Science
• Pediatric Pulmonology

Background:

• Less Invasive Surfactant Administration (LISA) offers potential benefits over the INtubate, SURfactant, Extubate (INSURE) method for preterm infants.
• The INSURE method involves transient intubation and positive pressure ventilation, which may lead to adverse effects.
• Optimizing LISA delivery requires systematic approaches to quality improvement.

Purpose of the Study:

• To demonstrate the application of the Plan-Do-Study-Act (PDSA) cycle for enhancing Less Invasive Surfactant Administration (LISA) quality improvement.
• To identify opportunities for intervention and improve clinical outcomes through interprofessional collaboration in a LISA initiative.
• To share a replicable model for improving surfactant delivery in neonatal intensive care units.

Main Methods:

• A quality improvement project utilized PDSA cycles within a level III neonatal intensive care unit.
• An interprofessional team analyzed compliance rates, infant outcomes, and clinician feedback monthly.
• Interventions included developing a LISA checklist and video, optimizing equipment storage, standardizing charting, and providing re-education.

Main Results:

• LISA compliance increased from 47% to 100% within two months, replacing the INSURE method for eligible infants.
• Significant improvements in infant outcomes were observed, including reduced rates of grade III/IV intraventricular hemorrhage (IVH) and chronic lung disease (CLD).
• The percentage of infants requiring a second surfactant dose decreased, and the LISA protocol was expanded to other network hospitals.

Conclusions:

• The PDSA cycle is an effective framework for driving quality improvement in Less Invasive Surfactant Administration (LISA) protocols.
• Interprofessional collaboration is crucial for successful implementation and sustained adherence to evidence-based neonatal care practices.
• Optimized LISA delivery can lead to better clinical outcomes for preterm infants, reducing the incidence of serious morbidities.