379 - Improving Time at Target Oxygen Saturation in Preterm Infants: A Quality Improvement Initiative

Poster Number: 379
Publication Number: 379.434

Yi Sun, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (People's Republic); Cuizhen Gao, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China (People's Republic); Xiaoyan Sha, Guangzhou Women's and children's Medical Center, Guangzhou, Guangdong, China (People's Republic); Ping Wang, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (People's Republic); Sijie Song, Chongqing health center for women and children, Chongqing, Chongqing, China (People's Republic); Xiaowei li, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (People's Republic); Yuan Yuan, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (People's Republic); Xin Qin, guangzhou women and children's medical center, guangzhou, Guangdong, China (People's Republic); Li Sun, Guangzhou women and children's medical center, Guangzhou, Guangdong, China (People's Republic); Xiaopeng Zhao, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (People's Republic); John Chuo, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Huayan Zhang, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: Based on high quality research, pulse oximetry oxygen saturation (SpO2) target of 90-94% has been widely accepted for extremely preterm infants receiving oxygen therapy. However, this target is not easily achievable in a busy neonatal intensive care unit (NICU). Auditing of the SpO2 histogram recording revealed that the extremely preterm infants in our unit spend the majority of their time outside this saturation target range.

Objective: The purpose of this project was to increase the daily percent time that remains at target SpO2 from 25.7% to 40% in 6 months in preterm infants on oxygen therapy who were born at ≤32weeks and until they reached 34 weeks postmenstrual age(PMA).

Design/Methods: This project was initiated in our 90-bed NICU on June 16, 2021. After baseline data collection, we organized a multidisciplinary QI team including physicians, nurses, respiratory therapists, chief residents, and fellows. Based on the identified key drivers (Figure 1), a series of interventions were implemented and tested in PDSA cycles: 1) creating a unit clinical policy for target saturation among preterm infants; 2) developing a practice guide for bedside oxygen titration (Figure 2); 3) implementing new policy to allow nurses adjusting inspired oxygen; and 4) carrying out a series of staff education. Utilizing the SpO2 histogram from the cardiorespiratory monitor, we recorded the daily percent time that each eligible patient spent with oxygen saturation < 90%, within 90-94% and ≥95% . Outcome measure was percent at target SpO2 of 90-94%. Process measure was the rate of correct alarm limit setting. Balancing measures included time spent below 90%. In addition, staff knowledge was assessed via surveys at the starting of the project and then periodically after education sessions.

Results: The project included 34 patients from June to December 2021. The daily percent time at target SpO2 increased from the baseline of 25.7% at the beginning of the project to 44.5% in less than 5 months and was sustained (Figure 3). Meanwhile, percent time ≥95% decreased from 61.6% to 37.3% and percent time < 90% increased from 12.4% to 18.3%. The rate of correct alarm limit setting reached 100% at 3 months after the initiation of the project.Conclusion(s): The quality improvement intervention was successful in improving the percent time an extremely preterm infant spent in the target saturation range without increasing the risk of hypoxemia. A multidisciplinary team quality improvement approach is helpful in standardizing the care of extremely preterm infants in a busy NICU.
Figure 1. Drivers diagram
Figure 2. Guidance for oxygen titration for preterm infants in QI project