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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e432-e436

ELECTRONIC ARTICLE

Implementing Potentially Better Practices to Reduce Lung Injury in Neonates

Kelly Burch, PharmD*, William Rhine, MD{ddagger}, Robin Baker, MD§, Fern Litman, MD§, Joseph W. Kaempf, MD||, Edward Schwarz, MD*, Shyan Sun, MD, Nathaniel R. Payne, MD# and Paul J. Sharek, MD, MPH{ddagger}

* St John’s Mercy Medical Center, St Louis, Missouri
{ddagger} Lucile Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, California
§ Inova Fairfax Hospital for Children, Falls Church, Virginia
|| Providence St Vincent Medical Center, Portland, Oregon
St Barnabas Medical Center, Livingston, New Jersey
# Children’s Hospital and Clinics, Minneapolis, Minnesota

--> Objective. Adherence to basic quality improvement principles enhances the implementation of potentially better practices (PBPs) and requires extensive planning and education. Even after PBPs have been identified and acknowledged as desirable, effective implementation of these practices does not occur easily. The objective of this study was to identify and assess implementation strategies that facilitate quality improvements in the respiratory care of extremely low birth weight infants.

Methods. The 9 members of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000 Reducing Lung Injury focus group identified 9 PBPs in a evidence-based manner to decrease chronic lung disease in extremely low birth weight newborns. Each site implemented several or all PBPs based on a site-specific selection process. Each site was asked to submit 1 or more examples of experiences that highlighted effective implementation strategies. This article reports these examples and emphasizes the principles on which they are based.

Results. The 9 participating institutions implemented a total of 57 PBPs (range: 1–9; median: 5). Including previous implementation, the 9 participating institutions implemented a total of 70 of a possible 81 PBPs before or during the study period (range: 5–9; median: 8). We report 7 approaches that facilitated PBP implementation: information availability, feedback, perseverance, collaboration, imitation, recognition of implementation complexity, and tracking of process indicators.

Conclusions. Quality improvement efforts are enhanced by identifying and then implementing PBPs. In our experience, implementation of these PBPs can be difficult. Implementation strategies, such as those identified in this article, can improve the chances that quality improvement efforts will be effective.

Key Words: collaborative quality improvement • chronic lung disease • extremely low birth weight infants • best practice • NIC/Q 2000

Abbreviations: ELBW, extremely low birth weight • PBPs, potentially better practices • ReLI, Reduce Lung Injury • NIC/Q 2000, Neonatal Intensive Care Quality Improvement Collaborative Year 2000 • VON, Vermont Oxford Network • CLD, chronic lung disease • NICU, neonatal intensive care unit • NCPAP, nasal continuous positive airway pressure • RCP, respiratory care practitioner

Received for publication Aug 13, 2002; Accepted Oct 24, 2002.