Targeting discrepancies in linear growth measurements in the neonatal intensive care unit through nursing interventions: a quality improvement initiative.

Abstract

Objective: Accurate length measurements are essential for infants to identify growth deficiencies and adjust nutrition accordingly. The gold standard for length measurement in infants is using a length board with two people to obtain an accurate clinical assessment. We aimed to improve the number of measurements with the desired minimal difference, defined as a discrepancy ≤1 cm between nurse and audit measurements, in our center. Our secondary aim was to increase and maintain the number of length boards available.

Methods: This quality improvement (QI) study used a before-and-after intervention comparison design in a single-level IV neonatal intensive care unit between June 2023 and December 2023, completing two Plan-Do-Study-Act (PDSA) cycles and one sustainability cycle that targeted nursing interventions. Blinded audits were performed by the QI team < 48 h after bedside nurse measurement and discrepancies between measurements were recorded. Chi-squared testing determined the significance between measurement discrepancies at each time point.

Results: The QI team measured 34 infants at each time point for 136 total measurements. There was a significant improvement in the desired minimal difference between the pre-intervention and post-PDSA #2 groups (38% vs 74%, p = 0.003) and between the pre-intervention and sustainability cycle groups (38% vs 71%, p = 0.007). There was no significant difference between PDSA #2 and our sustainability cycle. There was a 32% improvement among infants with consistent length percentiles between nurse and audit measures after PDSA #2 (42% vs 74%, p = 0.012). The number of length boards was increased during the study. Anonymous nursing surveys revealed an improvement in the perceived ease of use of length boards (51-71%) and minimized knowledge gaps.

Conclusions: During the time of our intervention, there was an improvement in the precision of linear measurements and length board usage. Future PDSA cycles will focus on increasing the availability of length boards and establishing continued length board education.