Oxytocin Guidelines Associated with Compliance to National Standards.

Objective: Develop a multidisciplinary, consensus-driven, evidence-based approach to oxytocin use, while adhering to national guidelines.

Design: This was a quality improvement project that used the Plan Do Study Act method to create cycles of change over several years. To initiate discussion, a survey was administered at a social event for providers from divergent community practices that addressed the controversial aspects of oxytocin use.

Implementing Standardized Feeding Guidelines, Challenges, and Results.

Purpose: The purpose of this article was to develop standardized nutritional guidelines that would promote increased growth velocity (GV) in premature infants.

Design: Evidence-based standardized nutritional guidelines were developed. Guidelines included total parenteral nutrition advancement; enteral feeding advancement; and a bedside nurse gastric residual management algorithm.

Improving pain assessment in the NICU: a quality improvement project.

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.

Optimizing therapeutic hypothermia for neonatal encephalopathy.

Objective: Therapeutic hypothermia (TH) for neonatal encephalopathy is becoming widely available in clinical practice. The goal of this collaborative was to create and implement an evidence-based standard-of-care approach to neonatal encephalopathy, deliver consistent care, and optimize outcomes.

Methods: The quality improvement process identified and used the Model for Improvement as a framework for improvement efforts.

Magnetic resonance imaging studies without sedation in the neonatal intensive care unit: safe and efficient.

Use of magnetic resonance imaging (MRI) in the neonatal intensive care unit has been increasing over the past several years because of improved MRI technology and increased clinical awareness of the prognostic and diagnostic information available. Historically, the use of sedation has been the standard for achieving quality imaging without motion artifact, but it exposed the patient to risks associated with sedation medications. In an effort to obtain MRI studies with elimination of risks associated with sedation, a quality improvement project was initiated.

Standardizing nasal cannula oxygen administration in the neonatal intensive care unit.

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.

Overcoming barriers to oxygen saturation targeting.

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.