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Category: Volume 07 Issue 07 July 2019
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Title: Reduction of Inappropriate Use of Oxygen by Standardizing Initiation of Simple Check List among Neonates Admitted in Newborn Care Unit: A Quality Improvement Initiative

Authors: Narendra Behera, Dr Jayanti Prava Behera

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.134

Abstract

Introduction: Preterm and term infants are more frequently exposed to high concentrations of oxygen for prolonged periods. When supplemental oxygen is needed for care, it will be prudent to avoid fluctuations in SpO2. The definition of the safest level of oxygen saturations in the neonate remains an area of active research. On the basis of the recently published evidences, the most suitable approach would be to set an alarm limits between 90 and 95%.

Objective: To reduce the inappropriate use of O2 (concentration and duration) by implementation of standard protocol, which is done by quality improvement strategy.

Materials and Methods: This is a quality improvement study conducted in a tertiary care children’s health institution in India. Pre interventional and post interventional data are collected from hospital records of 69 and101 hospitalized newborn cases respectively. By Q.I method, first prioritization of problem and research team formation, then clear aim statement about study is discussed prior to data collection. In 2nd step analysis of problems and the team members tried to solve this problem by using the fish bone analysis method. Then the changes are made as per PDSA cycle (CME about implementation of new protocol, reorientation of staffs, some changes made in emergency department. Initially smaller changes then multiple and larger events done). The final data are analyzed and compare with baseline data.

Results: There reduction of duration and concentration of O2 use is observed as < 2 days duration in final data i.e 69.7% which is significantly more than base line data (23%). Appropriate use of O2 among neonates is significantly increased after implementation of quality improvement strategy (67.96%) over base line data (19%). In final data mean O2 therapy is 1-2 days in comparison with base data i.e 3-5 days. There are no significant changes in outcome parameters.

Conclusion: Practice recommendation of O2 saturation targets newborn cared with minimizing oxygen therapy and toxicity.

Keywords: Oxygen, newborn, SPO2, preterm, free radicals.

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Corresponding Author

Narendra Behera

Associate Prof. Pediatric, S.C.B Medical College, Cuttack, India