Cargando…
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...
Autores principales: | , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1784861054997626880 |
---|---|
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. |
format | Online Article Text |
id | pubmed-9799173 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT diegoellenk implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT malloykatherine implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT coxtoby implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT broomallallison implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT orrlaura implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT baxterchristina implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT meanysarah implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT bakernicole implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT fraserjennifer implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT corbinkellysanders implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT gregoskimathewj implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT wagnercaroll implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations AT rossjulier implementationofastandardizedpremedicationbundletoimproveproceduresuccessfornonemergentneonatalintubations |