Pain assessment documentation was inadequate because of the use of a subjective pain assessment strategy in a tertiary level IV neonatal intensive care unit (NICU). The aim of this study was to improve consistency of pain assessment documentation through implementation of a multidimensional neonatal pain and sedation assessment tool. The study was set in a 60-bed level IV NICU within an urban children's hospital.
View Article and Find Full Text PDFBackground: A Midwestern neonatal intensive care unit (NICU) employs a multidisciplinary conference, the Comprehensive Care Round (CCR), to facilitate communication and consensus building and thereby prevent or address moral distress within the health care team.
Methods: A cross-sectional survey, 3 years after implementation of CCR, to evaluate health care providers' (HCP) perceptions of comfort with expressing distress, support from team members in care situations that evoke moral distress, barriers to communication, and attainment of CCR objectives.
Results: Of 370 HCP, 116 (31%) participated in the survey (42% nurses, 37% allied health, and 21% medical); 51% had previously attended CCR.
Objective: A multicycle, quality improvement method was used to standardize nasal cannula O2 administration and weaning in the NICU.
Methods: A 2-armed nasal cannula standardized order form (nasal cannula for stable O2 arm and nasal cannula for stable flow arm) was developed after review of the literature, surveying of the practice of NICU physicians and nurse practitioners, and development of consensus among these providers. Outcomes were measured by tracking the distribution of protocol arm chosen, days on O2, weeks on nasal cannula, and disposition of infants who were supported by nasal cannula.
Objective: To reduce hyperoxia in very low birth weight infants who receive supplemental oxygen, the Children's Mercy Hospital neonatal respiratory quality improvement committee introduced the potentially better practice of oxygen saturation targeting and identified strategies to overcome barriers to implementation of this practice.
Methods: Using rapid-cycle quality improvement projects, this center adapted an oxygen saturation targeting protocol and tracked hourly oxygen saturation as measured by pulse oximetry in very low birth weight infants who received supplemental oxygen.
Results: The percentage of time in the range of 90% to 94% of oxygen saturation as measured by pulse oximetry increased from 20% to an average of 35% after implementation of the protocol.