Measuring practice preference variation for quality improvement in neonatal respiratory care.

Objectives: The authors sought to measure and compare practice preference variation in neonatal respiratory care within and between neonatal intensive care units (NICUs) using the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT).

Study Design: Eleven NICUs completed the NSIGHT between 2019 and 2021. Net preference was measured by mean response; agreement was ranked by standard distribution of response values.

Improving the quality of quality metrics in neonatology.

This article examines approaches for improving the efficiency and effectiveness of quality metrics currently in use in neonatal care. Desirable characteristics of quality metrics are discussed, the criteria and process for their development are presented, and the uses and limitations of current neonatal outcome and process metrics are explored together with approaches for improving metric performance. Discussion includes enhancing quality metrics through optimizing improvement readiness, sustaining improvements once achieved, and use of improvement science methods to improve metric validity.

Reducing Alarm Fatigue in Two Neonatal Intensive Care Units through a Quality Improvement Collaboration.

Objective: To reduce nonactionable oximeter alarms by 80% without increasing time infants were hypoxemic (oxygen saturation [SpO] ≤ 80%) or hyperoxemic (SpO > 95% while on supplemental oxygen).

Study Design: In 2015, a multidisciplinary team at Connecticut Children's Medical Center initiated a quality improvement project to reduce nonactionable oximeter alarms in two referral neonatal intensive care units (NICUs). Changes made through improvement cycles included reduction of the low oximeter alarm limit for specific populations, increased low alarm delay, development of postmenstrual age-based alarm profiles, and updated bedside visual reminders.

Alarm Safety and Alarm Fatigue.

Clinical alarm systems have received significant attention in recent years following warnings from hospital accrediting and health care technology organizations regarding patient harm caused by unsafe practices. Alarm desensitization or fatigue from frequent, false, or unnecessary alarms, has led to serious events and even patient deaths. Other concerns include settings inappropriate to patient population or condition, inadequate staff training, and improper use or disabling.

Nurse:patient ratio and achievement of oxygen saturation goals in premature infants.

Background: Premature newborns often experience oxygen saturations outside policy-specified targets, which may be associated with increased morbidity. Nurse workload may affect oxygen management.

Objective: To examine the relationship between number of patients assigned to neonatal intensive care unit (NICU) nurses and achievement of oxygen saturation goals in premature newborns.