241 - Increased Adherence to a Neonatal Care Bundle Reduced the Rate of Severe Intraventricular Hemorrhage in Very Low Birth Weight Neonates

Poster Board #: 241
Publication #: 2912-HP-QA.241

Background: Very low birth weight (VLBW) infants are at higher risk of developing severe (grade III and IV) intraventricular hemorrhage (IVH) within the first 72 hours of life. Evidence-based neonatal care bundles have been implemented to decrease the occurrence of severe IVH.


Objective: To decrease the rate of severe IVH in VLBW infants by 50% from a baseline of 10.4% to 5% in our single-center, level III neonatal intensive care unit (NICU) over 2 years by improving adherence to our neonatal care bundle


Design/Methods: After assessing potential drivers of change, 5 point interventions were designed and implemented sequentially: (1) In-service training of nurses and respiratory therapists (2) Improve awareness by regular huddles and mnemonic use (3) Revise clinical care guidelines to improve adherence to care bundle (i.e. feeds over pump) (4) Initiate bundle in delivery room and check availability of equipment, and (5) Collect per nursing shift audit data (Figure 1). Adherence to the neonatal care bundle was scored on a novel, three-point system and compared using Kruskal-Wallis test (Figure 2). The incidence of severe IVH was tracked every month and was plotted on a control chart after fixing the mean from baseline data (2016-2018). Pre- and post-intervention groups were compared using Fisher’s exact test and the Mann-Whitney U-test.


Results: Adherence to the neonatal care bundle improved from 24% to 90% over 2 years with completion of the sequential 5 PDSA cycles. The rate of severe IVH in VLBW infants decreased from 10.4% to 4.3% over 2 years (Figure 3). Baseline patient characteristics were similar in pre- and post-intervention groups (Table 1). In addition, an increased adherence score was correlated with reduction in severe IVH in VLBW infants. (Figure 2).

Conclusion(s): A multidisciplinary QI initiative of process improvement centered on enhanced adherence of an evidence-based neonatal care bundle successfully reduced the rate of severe IVH in VLBW infants.

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Authors/Institutions: Sarah E. Kolnik, University of Washington, Bothell, Washington, United States; Kimberly Jones, University of Washington, Bothell, Washington, United States; Kirtikumar Upadhyay, University of Washington, Bothell, Washington, United States; Sandra E. Juul, University of Washington, Seattle, Washington, United States; Gregory C. Valentine, University of Washington, Tacoma, Washington, United States