Paul Cawley 1, Ian Long 2, Claire O’Mara 2, Mark Dyke 1
1. Neonatal Intensive Care Unit, Norfolk & Norwich University Hospital, UK 2. East of England Neonatal ODN, hosted at Cambridge University Hospitals NHS Foundation Trust, UK
Introduction (include hypothesis)
For the past 5 years, the East of England Neonatal Network has undertaken a quality improvement initiative to improve early newborn care across all 17 neonatal units, with a regional birth rate of >70,000 per annum. Audit of key standards has formed an important part of this project. We aimed to assess how early newborn care within our region has responded to our quality improvement interventions over time.
Methods (include source of funding and ethical approval if required)
From 2014 to 2018 our network has undertaken 3 quality improvement cycles across 4 related care bundles: Antenatal, Thermoregulation, Respiratory and Fluids & Medications. Design: Plan-Do-Study-Act. Key quality measures were audited on a unit level. We developed electronic spreadsheets with data validation & easy-to-use interface to optimise data collection. Principal interventions included: Regional education days, production of a universal admission care booklet and development of a quick reference manual, accessible in print & electronic form. Analysis: 2 sided Chi-Square.
n=1,480. 100% response all units. Gestational range 23+0-42+2 weeks & birth weight 380-5460g. Our admission booklet guided care in 82%. In extremely preterm infants: Antenatal corticosteroid use [75 to 95%, p=0.001] & magnesium sulphate use [24 to 54%, p=0.001] increased. Thermoregulatory measures improved [Plastic Bag use 86 to 99%, p<0.0001; Hat use 64 to 95%, p<0.0001]. Use of delivery room Positive-End Expiratory Pressure [47 to 78%, p<0.0001] & optimal first dose surfactant [47 to 75%, p=0.01] improved. Proportion of infants not intubated or intubated for surfactant instillation only increased [2% to 26%, p=0.001]. Documented parent involvement at delivery increased [45% to 88%, p<0.0001]. Proportion of infants receiving antibiotics [58 to 67%, p=0.55] & fluids [67 to 85%, p=0.018] in 1 hour increased. (Example figure: arrows = interventions)
Mechanisms unique to the network model have streamlined dissemination of practice, guideline development & in-depth audit. Strong drivers & enthusiastic staff facilitated rapid uptake. Modest but progressive improvements have occurred. Ongoing improvement is still required: we now plan targeted intervention to these key areas.
References (include acknowledgement here if appropriate)
We would like to thank all members of the First Hour of Care working group for their invaluable hard work throughout this project and all neonatal staff in our region for their continued enthusiasm