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Optimizing Nurse-Led Rounds to Reduce Ventilator Days in a Bronchopulmonary Dysplasia Cohort
Mary Elizabeth Loughran1, Renea Powell
1Author Affiliations: Louise Herrington School of Nursing, Baylor University, Houston, Texas (Dr Loughran); and Texas Children's Hospital, Houston, Texas (Dr Powell).
Insights
Nurse-led rounds using optimized respiratory scripts improved neonatal intensive care unit (NICU) nurses' confidence and knowledge. This initiative also enhanced interdisciplinary collaboration, benefiting respiratory outcomes for infants with bronchopulmonary dysplasia (BPD).
Area of Science:
- Neonatal care
- Quality improvement initiatives
- Respiratory medicine
Background:
- Neonatal intensive care unit (NICU) nurses play a crucial role in patient outcomes via respiratory weaning protocols, but this is not standard practice.
- Infants born extremely prematurely (<28 weeks gestational age) are at high risk for severe bronchopulmonary dysplasia (BPD).
- Reducing invasive mechanical ventilation (iMV) exposure is key to mitigating BPD severity but remains challenging.
Purpose of the Study:
- To assess the impact of optimized nurse-led rounds scripts on interdisciplinary rounding and iMV time in a BPD cohort.
- To evaluate the effectiveness of the Plan-Do-Study-Act cycle and Lewin's Change Theory in a quality improvement initiative.
- Objectives included enhancing nurse education, script compliance, and reducing iMV duration.
Main Methods:
- Implementation of nurse-led rounds utilizing an optimized respiratory script for a cohort of patients with BPD.
- Comparison of nurses' confidence, autonomy, and respiratory knowledge before and after a 90-day implementation period.
- Retrospective review of iMV time for the BPD patient cohort.
Main Results:
- Daily script usage reached 61% by day 90.
- Educational components were completed by 99% of participating nurses.
- Significant increases were observed in nurses' confidence, respiratory knowledge, and sense of autonomy.
Conclusions:
- Nurse-led rounds scripts enhance leadership and interdisciplinary collaboration among NICU nurses.
- The initiative demonstrated positive effects on respiratory outcomes for NICU patients.
- Optimized scripts represent a valuable tool for improving care quality in the NICU setting.
Background:
Intensive care unit (ICU) nurses improve patient outcomes through respiratory weaning protocols, yet this is not standard practice in the neonatal ICU (NICU). Infants born extremely prematurely, <28 weeks gestational age, are at risk for the development of severe bronchopulmonary dysplasia (BPD). Reducing exposure to invasive mechanical ventilation (iMV) can reduce the severity of BPD, yet it remains a challenge.
Purpose:
This quality improvement initiative assessed the effect of optimizing nurse-led rounds scripts on the interdisciplinary rounding structure and explored iMV time among infants in a BPD cohort. The 3 objectives were education, script compliance, and iMV time. The project was guided by the Plan-Do-Study-Act cycle model and Lewin's Change Theory. Implementation occurred in a level IV NICU within a single children's hospital. The population included 240 NICU nurses, 57 neonatal nurse practitioners, and 118 neonatologists caring for a cohort of 18 patients with BPD.
Methods:
Nurses-led rounds through an optimized respiratory script for a cohort of patients with BPD. After 90 days of implementation, nurses' confidence, autonomy, and respiratory knowledge were compared. iMV time for the patients with BPD was retrospectively reviewed.
Results:
Daily script usage improved to 61% by day 90. Education was completed by 99% of the nurses. The nurse's confidence, knowledge, and sense of autonomy all increased.
Implications For Practice And Research:
These results indicate that nurse-led rounds scripts benefit NICU nurses' leadership, improve interdisciplinary collaboration, and improve respiratory outcomes for NICU patients.
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