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Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations

The American Academy of Pediatrics recommends premedication for all nonemergent neonatal intubations, yet there remains significant variation in this practice nationally. We aimed to standardize our unit’s premedication practices for improved intubation success and reduced adverse events. METHODS: T...

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Autores principales: Diego, Ellen K., Malloy, Katherine, Cox, Toby, Broomall, Allison, Orr, Laura, Baxter, Christina, Meany, Sarah, Baker, Nicole, Fraser, Jennifer, Corbin, Kelly Sanders, Gregoski, Mathew J., Wagner, Carol L., Ross, Julie R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799173/
https://www.ncbi.nlm.nih.gov/pubmed/36601630
http://dx.doi.org/10.1097/pq9.0000000000000622
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author Diego, Ellen K.
Malloy, Katherine
Cox, Toby
Broomall, Allison
Orr, Laura
Baxter, Christina
Meany, Sarah
Baker, Nicole
Fraser, Jennifer
Corbin, Kelly Sanders
Gregoski, Mathew J.
Wagner, Carol L.
Ross, Julie R.
author_facet Diego, Ellen K.
Malloy, Katherine
Cox, Toby
Broomall, Allison
Orr, Laura
Baxter, Christina
Meany, Sarah
Baker, Nicole
Fraser, Jennifer
Corbin, Kelly Sanders
Gregoski, Mathew J.
Wagner, Carol L.
Ross, Julie R.
author_sort Diego, Ellen K.
collection PubMed
description The American Academy of Pediatrics recommends premedication for all nonemergent neonatal intubations, yet there remains significant variation in this practice nationally. We aimed to standardize our unit’s premedication practices for improved intubation success and reduced adverse events. METHODS: The study workgroup developed educational material and protocol content. Process measures included premedication use, education, and audit form completion. Primary (success on first intubation attempt and adverse event rates) and secondary (trainee success) study outcomes are displayed using statistical process control charts and pre-post cohort comparisons. RESULTS: Forty-seven percent (97/206) of nurses completed educational intervention before protocol release, with an additional 20% (42/206) following a staff reminder. Two hundred sixteen (216) patients were intubated per protocol with 81% (174/216) audit completion. Compared with baseline (n = 158), intubation attempts decreased from 2 (IQR, 1–2) to 1 (IQR, 1–2) (P = 0.03), and success on the first attempt increased from 40% (63/158) to 57% (124/216) (P < 0.01), with a notable improvement in trainee success from less than 1% (1/40) to 43% (31/72) (P < 0.01). The rate of severe and rare adverse events remained stable; however, there was a rise in nonsevere events from 30% (48/158) to 45% (98/216). The tachycardia rate increased with atropine use. There was no change in chest wall rigidity, number of infants unable to extubate following surfactant, or decompensation awaiting medications. CONCLUSIONS: Standardizing procedural care delivery reduced intubation attempts and increased the attempt success rate. However, this was accompanied by an increase in the rate of nonsevere adverse events.
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spelling pubmed-97991732023-01-03 Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations Diego, Ellen K. Malloy, Katherine Cox, Toby Broomall, Allison Orr, Laura Baxter, Christina Meany, Sarah Baker, Nicole Fraser, Jennifer Corbin, Kelly Sanders Gregoski, Mathew J. Wagner, Carol L. Ross, Julie R. Pediatr Qual Saf Individual QI projects from single institutions The American Academy of Pediatrics recommends premedication for all nonemergent neonatal intubations, yet there remains significant variation in this practice nationally. We aimed to standardize our unit’s premedication practices for improved intubation success and reduced adverse events. METHODS: The study workgroup developed educational material and protocol content. Process measures included premedication use, education, and audit form completion. Primary (success on first intubation attempt and adverse event rates) and secondary (trainee success) study outcomes are displayed using statistical process control charts and pre-post cohort comparisons. RESULTS: Forty-seven percent (97/206) of nurses completed educational intervention before protocol release, with an additional 20% (42/206) following a staff reminder. Two hundred sixteen (216) patients were intubated per protocol with 81% (174/216) audit completion. Compared with baseline (n = 158), intubation attempts decreased from 2 (IQR, 1–2) to 1 (IQR, 1–2) (P = 0.03), and success on the first attempt increased from 40% (63/158) to 57% (124/216) (P < 0.01), with a notable improvement in trainee success from less than 1% (1/40) to 43% (31/72) (P < 0.01). The rate of severe and rare adverse events remained stable; however, there was a rise in nonsevere events from 30% (48/158) to 45% (98/216). The tachycardia rate increased with atropine use. There was no change in chest wall rigidity, number of infants unable to extubate following surfactant, or decompensation awaiting medications. CONCLUSIONS: Standardizing procedural care delivery reduced intubation attempts and increased the attempt success rate. However, this was accompanied by an increase in the rate of nonsevere adverse events. Lippincott Williams & Wilkins 2022-12-27 /pmc/articles/PMC9799173/ /pubmed/36601630 http://dx.doi.org/10.1097/pq9.0000000000000622 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Individual QI projects from single institutions
Diego, Ellen K.
Malloy, Katherine
Cox, Toby
Broomall, Allison
Orr, Laura
Baxter, Christina
Meany, Sarah
Baker, Nicole
Fraser, Jennifer
Corbin, Kelly Sanders
Gregoski, Mathew J.
Wagner, Carol L.
Ross, Julie R.
Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations
title Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations
title_full Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations
title_fullStr Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations
title_full_unstemmed Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations
title_short Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations
title_sort implementation of a standardized premedication bundle to improve procedure success for nonemergent neonatal intubations
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799173/
https://www.ncbi.nlm.nih.gov/pubmed/36601630
http://dx.doi.org/10.1097/pq9.0000000000000622
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