Pediatric quality & safety最新文献

{"title":"Keep Moving: Sustainability of an Early Mobility Protocol in an Academic Pediatric ICU.","authors":"Jenna E Domann, Lindsay E Davies, Elizabeth E Zivick, Laken Johnson, Everette P Keller, Alice A Walz","doi":"10.1097/pq9.0000000000000783","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000783","url":null,"abstract":"<p><strong>Introduction: </strong>Mobilization protocols are safe and feasible for critically ill pediatric patients in the intensive care unit (ICU), but barriers exist to sustainability. This study described a focused early mobility protocol, sustained over 5 years, which is on time for therapy consults and patient mobilization at a single institution.</p><p><strong>Methods: </strong>A formal ICU mobility protocol was implemented as part of a unit-wide ICU liberation bundle. As part of the ongoing program assessment, over a specific 3-month timeframe annually from 2017 to 2023, the number of physical and occupational therapy (PT/OT) consults, mobilization rate, and time to PT/OT consult were analyzed. In addition, in 2023, we assessed specific barriers to early PT/OT consultation.</p><p><strong>Results: </strong>Annually, for each study timeframe, there was a sustained decrease in time to therapy consult from a mean of 3.8 days for PT and 7 days for OT in 2017 to 1.9 and 1.6 days, respectively, in 2023. Similarly, the mobilization rate increased from 20.3 sessions per 100 patient days in 2017 to 48.2 in 2023. There was a trend toward missed or delayed therapy consults at times of higher ICU census. No adverse events were associated with mobilization.</p><p><strong>Conclusions: </strong>An ICU early mobility protocol leads to a sustained decrease in the time to therapy consultation, an increase in the number of therapy consults, and an increase in the mobilization rate. Future interventions should focus on mitigating barriers to timely consultation, specifically at times of higher ICU census.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e783"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Late-arriving Surgeons in Support of First-case On-time Starts.","authors":"Jonathan B Ida, Jamie H Schechter, John Olmstead, Archana Menon, Mary Beth Iafelice, Amod Sawardekar, Olga Leavitt, Jennifer M Lavin","doi":"10.1097/pq9.0000000000000784","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000784","url":null,"abstract":"<p><strong>Introduction: </strong>First-case on-time starts (FCOTS) is an established metric of perioperative efficiency, impacting global perioperative throughput. Late-arriving surgeons are a common cause of late operating room (OR) starts. This project reflects a quality improvement effort to reduce late surgeon arrivals by 30% for 24 months and improve FCOTS.</p><p><strong>Methods: </strong>A multidisciplinary perioperative leadership team developed clear expectations, including tracking, roles, review processes, and consequences. These were broadly communicated among stakeholders, and feedback was incorporated. A new same-day surgeon-to-surgeon feedback mechanism was instituted for late surgeon arrivals, allowing for surgeon feedback and reiteration of expectations. Results were prospectively tracked for 24 months before and following implementation.</p><p><strong>Results: </strong>Late surgeon arrivals decreased by 45%, from 23.6 to 13 per month for 24 months before and following implementation, respectively (<i>P</i> < 0.001). Balancing measures did not see increases for the same periods. FCOTS increased from 66% to 72% postimplementation (<i>P</i> < 0.001). Statistical process control P-charts demonstrated centerline shifts for both metrics.</p><p><strong>Conclusions: </strong>Development and communication of a clear framework of expectations, review, and consequences, with ongoing monitoring, clear performance expectations, and timely feedback, can reduce late surgeon arrival and improve FCOTS. Direct and timely communication provided immediate feedback to late surgeons and indicated reporting errors, providing more accurate data on late starts. Consistent policy enforcement is critical for credibility.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e784"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Antibiotic Use in Argentine Pediatric Hospitals: A Process Evaluation Using Normalization Process Theory.","authors":"Javier Roberti, Facundo Jorro-Barón, Natalí Ini, Marina Guglielmino, Ana Paula Rodríguez, Cecilia Echave, Andrea Falaschi, Viviana E Rodríguez, Ezequiel García-Elorrio, Juan Pedro Alonso","doi":"10.1097/pq9.0000000000000788","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000788","url":null,"abstract":"<p><strong>Introduction: </strong>In the pediatric setting, overprescribing of antibiotics contributes to the rise of multidrug-resistant organisms. Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use and combat resistance. However, the implementation of ASPs in low- and middle-income countries faces several challenges. This study aimed to evaluate the implementation process of a multifaceted ASP in 2 pediatric hospitals in Argentina.</p><p><strong>Methods: </strong>A qualitative study was conducted in two large public children's hospitals in Argentina, using semistructured interviews with 32 healthcare providers at the beginning and end of the ASP implementation. The study was guided by the normalization process theory.</p><p><strong>Results: </strong>The intervention faced challenges, including limited understanding of its objectives, confusion with existing practices, and insufficient commitment from senior staff. Although junior staff were more receptive, communication barriers with external staff and workload concerns hindered broader adoption. Infectious disease specialists primarily led implementation, with limited involvement of other staff, particularly in training activities. Despite these challenges, participants reported improvements, such as the development of standardized antibiotic guidelines, better interdisciplinary collaboration, and improved communication. However, organizational support and resistance to new practices remained barriers.</p><p><strong>Conclusions: </strong>This study highlights the importance of organizational context and staff commitment in ASP implementation. Tailored strategies that address the specific challenges of low- and middle-income countries are needed to effectively implement ASPs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e788"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitioning to Opioid-free Anesthesia for Pediatric Supracondylar Fracture Repairs: A Patient Safety Report.","authors":"Laurence O Henson, Jennifer Chiem, Emmanuella Joseph, Fiona Patrao, Daniel King-Wai Low","doi":"10.1097/pq9.0000000000000777","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000777","url":null,"abstract":"<p><strong>Introduction: </strong>Supracondylar fractures are among the most common injuries in the pediatric population. Recently, there has been increased interest in developing opioid-free anesthetic protocols that achieve these same goals without the risks associated with opioid use, such as postoperative nausea and vomiting (PONV), delayed discharges, and respiratory depression.</p><p><strong>Methods: </strong>Seattle Children's Hospital implemented opioid-free anesthesia (OFA) for pediatric supracondylar fracture repairs in January 2021. This patient safety report compares the clinical outcomes of these patients to those who received intraoperative opioids. Clinical effectiveness was measured using the maximum pain scores in the postanesthesia care unit (PACU), postoperative opioid rescue rates in PACU and PONV rescue rate. PACU length of stay (LOS) was chosen as a clinical balancing measure.</p><p><strong>Results: </strong>The opioid group (n = 464) had a mean maximum pain score of 3.39 compared with the OFA group (n = 816), which had a mean maximum of 3.70. The PACU IV opioid rescue rate for the opioid group was 38.82%, whereas the OFA group was 38.73%. The opioid group had a PONV rescue rate of 1.53%, compared with 0.23% in the OFA group. Mean LOS in the PACU was 79 minutes for the opioid group and 86 minutes for the OFA group.</p><p><strong>Conclusions: </strong>The shift to OFA for intraoperative management of patients' supracondylar fracture repair resulted in similar postoperative analgesic outcomes when compared with an opioid-based approach, with a reduced PONV rate and minimal increase in LOS. Transitioning to OFA provided a safe and effective protocol for supracondylar repairs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e777"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from a Quality Improvement Initiative to Increase COVID-19 Vaccination in Hospitalized Children.","authors":"Daniel G Young, Cortney S Rogers, Isaac Mayefsky, Thomas Neufeld, Angela Niesen, Patrick J Reich, Carol M Kao, Mythili Srinivasan","doi":"10.1097/pq9.0000000000000782","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000782","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric coronavirus disease 2019 (COVID-19) vaccination rates in the United States remain lower compared with adults. We aimed to (1) implement a quality improvement initiative to increase COVID-19 vaccination 2-fold in hospitalized patients 12-21 years of age from 4.7% during the baseline period (August 10, 2021-November 1, 2021) to 9.4% during the intervention phase (November 2, 2021-March 31, 2023) and (2) assess the importance of existing interventions and obtain feedback for future interventions to increase COVID-19 vaccination via a provider survey.</p><p><strong>Methods: </strong>We conducted the quality improvement initiative in the inpatient units of a freestanding children's hospital. Interventions included provider education, electronic medical record best practice alerts, monthly competition, parental counseling to increase vaccine acceptance, and ensuring vaccine availability. The primary outcome measure was the percentage of hospitalized patients 12-21 years of age who received COVID-19 vaccine. Providers addressing COVID-19 vaccination with patients, as documented by COVID-19-specific problem lists, were a process measure. Length of stay was a balancing measure.</p><p><strong>Results: </strong>Although COVID-19 vaccination increased 1.6-fold during the initial 5 months of interventions, the interrupted time series analysis did not show a significant impact of our interventions on vaccination. Documentation of COVID-19 vaccine-specific problem lists increased 1.9-fold during most of the intervention period. There was no significant (<i>P</i> = 0.61) difference in length of stay between children in the baseline and intervention groups.</p><p><strong>Conclusions: </strong>Despite our best efforts, we could not increase the number of COVID-19 vaccinations in our patients. Lessons learned suggest that creating a nurse-driven COVID-19 vaccine screening/ordering protocol and integrating COVID-19/influenza vaccination annually during influenza season can potentially increase vaccination rates, but further research is required.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e782"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Standardized Approach to Transition Improves Care of Young Adults with Inflammatory Bowel Disease.","authors":"Daphna Katz, Stephanie Lee, Vidiya Sathananthan, Liz Bayes Santos, Amber Langshaw","doi":"10.1097/pq9.0000000000000786","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000786","url":null,"abstract":"<p><strong>Introduction: </strong>Young adults with inflammatory bowel disease (IBD) are at the risk of poor outcomes when transferring to adult providers. We aimed to increase the percentage of patients with 14-17 years of age undergoing the transition of care and the percentage of patients 18-21 years of age initiating the transfer of care to 50% for 12 months. Our goal was also to improve patient satisfaction with the transfer process. Our balancing measure was not to increase the duration of IBD visits.</p><p><strong>Methods: </strong>We implemented 3 interventions through iterative plan-do-study-act cycles. To understand the impact of the interventions for 12 months, we used statistical process control charts. The duration of IBD visits was used as a balancing measure. We administered an anonymous satisfaction survey through the electronic health record.</p><p><strong>Results: </strong>Total transition discussions increased to a mean of 38% (n = 68). Transition discussions with patients 14-17 years of age increased from baseline, though not consistently. Patients 18-21 years of age initiating transfer of care increased to a mean of 5% (n = 1) following the first intervention and to a mean of 30% (n = 13) following our second and third interventions with special cause variation. There was no significant difference in the duration of IBD visits before and after the intervention period (<i>P</i> = 0.54). No patients were dissatisfied following our interventions.</p><p><strong>Conclusions: </strong>We saw improved transition discussions and transfer initiation rates by implementing the first steps of a new process to transition young adults with IBD.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e786"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Adherence to Lipid Screening in the Pediatric Cardiology Clinic: A Quality Improvement Project.","authors":"Rachel A Magnan, Thomas Murphy, Lauren Rosenthal, Aparna Prasad, Anjali Chelliah, Stuart Kaufman, Donna Timchak, Lindsey McPhillips, Saira Siddiqui","doi":"10.1097/pq9.0000000000000781","DOIUrl":"10.1097/pq9.0000000000000781","url":null,"abstract":"<p><strong>Introduction: </strong>Lipid screening identifies at-risk patients to facilitate cardiovascular risk reduction. National pediatric guidelines recommend universal lipid screening between 9-11 and 17-21 years of age. We aimed to improve adherence to lipid screening for all age-appropriate outpatient pediatric cardiology visits from a baseline of 35% to 90% between November 2021 and July 2023.</p><p><strong>Methods: </strong>All outpatient visits for patients 9-11 and 17-21 years were included. Chart review and an Epic electronic health record report identified patients screened, lipid test results, and need for further testing. A P-chart was generated. After establishing a baseline for 8 weeks, interventions, including an Epic dot phrase, group and individual feedback, and Epic best practice alert (BPA), were incorporated via plan-do-study-act cycles. Balancing measures included anonymous provider surveys on visit length and experience.</p><p><strong>Results: </strong>More than 1,700 patient visits were included. At baseline, 35% of all age-appropriate patients were screened. The Epic dot phrase prompted a positive shift with a new mean of 59% screened. Another change occurred after the BPA alert, with an increase in screening to 84%. Lipid screening prompted by this initiative found that 38% of those with testing results in Epic had abnormal results requiring follow-up. Providers did not report a significant change in visit length due to screening.</p><p><strong>Conclusions: </strong>Quality improvement interventions improved adherence to universal lipid screening guidelines. The Epic dot phrase and BPA facilitated positive shifts. These simple interventions can be spread to other practices to improve adherence to lipid screening and other guidelines.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e781"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Sedation for Pediatric Thoracic CT Imaging Using Volumetric Target-mode EKG Gating.","authors":"Summit H Shah, Cody M Young, Jessica Morrison, Margarita Chmil, Lynne Ruess, Rajesh Krishnamurthy","doi":"10.1097/pq9.0000000000000779","DOIUrl":"10.1097/pq9.0000000000000779","url":null,"abstract":"<p><strong>Introduction: </strong>Many children require sedation for imaging. We aimed to reduce sedation for thoracic (chest and cardiac) computed tomography (CT) scans in children 0-4 years old from 65% to 20% by December 2018 and to sustain.</p><p><strong>Methods: </strong>We counted baseline, intervention, and a follow-up period thoracic CT scans performed with sedation in children 0-4 years old. We developed a new volumetric target-mode electrocardiogram-gated CT imaging protocol to reduce scan time and control for factors that decrease image quality. Additional interventions included technologist training, communication to radiologists and clinicians, and eliminating a default request for sedation accompanying the electronic order for most thoracic CT scans. A statistical process control chart tracked data to study process changes over time.</p><p><strong>Results: </strong>During the baseline and intervention periods, 232 of 357 and 217 of 794 scans required sedation. Interventions created 2 centerline shifts. Overall, thoracic CT scans in children 0-4 years old requiring sedation decreased from 65% to 24% and was sustained 5 years later. No patients during the baseline period, one (1 of 794, 0.1%) during the intervention period and 2 (2 of 480, 0.4%) during the audit period 5 years later, initially had nondiagnostic nonsedated scans that required an additional scan with sedation.</p><p><strong>Conclusions: </strong>We developed a volumetric target-mode electrocardiogram-gated CT protocol, eliminated default sedation ordering, and trained and educated staff to reduce sedation in young children undergoing thoracic CT scans. The frequency of sedation for thoracic CT in children 0-4 years old decreased from 65% to 24% and was sustained after revising imaging parameters and eliminating a default sedation order.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e779"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Intubations and Related Risks in Neonates with Retinopathy of Prematurity Undergoing Laser Photocoagulation.","authors":"Vilmaris Quinones Cardona, Emma McNell Byrne, Novisi Arthur, Megan Young, Diane Lavery, Amanda Carroll, Swosti Joshi, Folasade Kehinde, Ogechukwu Menkiti","doi":"10.1097/pq9.0000000000000780","DOIUrl":"10.1097/pq9.0000000000000780","url":null,"abstract":"<p><strong>Introduction: </strong>Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022.</p><p><strong>Methods: </strong>We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020. Outcome, process, and balancing measures tracked the efficacy and safety of the quality improvement project.</p><p><strong>Results: </strong>We reduced the percentage of infants requiring intubation for laser photocoagulation from 100% (8/8) to 10% (1/10). We reduced the average time to return to baseline respiratory status from 224.1 to 33.8 hours (9.3d to1.4 d). Cardiorespiratory index scores slightly increased (1 to 1.2), and pain scores remained unchanged after interventions.</p><p><strong>Conclusions: </strong>A multidisciplinary team approach using a deep sedation guideline and noninvasive ventilation can safely reduce the requirement for intubation during laser photocoagulation with a faster return to baseline respiratory status.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e780"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Premedication for Neonatal Intubation: A Quality Improvement Initiative.","authors":"Michelle H Lucena, Toshiba Morgan-Joseph, Alecia Thompson-Branch","doi":"10.1097/pq9.0000000000000778","DOIUrl":"10.1097/pq9.0000000000000778","url":null,"abstract":"<p><strong>Introduction: </strong>Endotracheal intubation is frequent in the neonatal intensive care unit (NICU) but may result in neonatal distress and instability. Premedication reduces adverse effects, such as hypoxia, bradycardia, and pain. The Specific, Measurable, Achievable, Relevant and Time-Bound aim for this project was to increase premedication use for nonemergent neonatal intubation in a specific NICU from 22% to 80% from March 2021 to May 2023.</p><p><strong>Methods: </strong>We use quality improvement methodology to explain our theory for improvement. Our key driver diagram depicts this initiative's aims, key drivers, and interventions to increase premedication use for neonatal intubation. We defined exclusion criteria and medications, and one author collected demographic data retrospectively after the procedure. The stakeholders summarized the baseline data, performed plan-do-study-act cycles, and showed outcome measures in a statistical process control chart. Statistical analysis used Fisher's exact test to compare categorical variables.</p><p><strong>Results: </strong>Between 2021 and 2023, 333 infants underwent endotracheal intubation; 130 infants were included. The most common indication for intubation was hypoxemic respiratory failure-52% (68/130). Premedication use increased from 22% to 52%. Among the exclusion criteria, the most common indication for nonpremedication was intubation in the delivery room, 38.4% (78/203). In the premedication group, intubation on the first attempt occurred in 77.6% (52/67) of the cases, versus the nonpremedication group, 66.7% (32/48) (<i>P</i> = 0.3).</p><p><strong>Conclusions: </strong>Premedication for neonatal intubation increased by 30%, although we did not reach the desired 80% goal. Establishing a premedication bundle, alongside a unit-specific protocol and effective teamwork, marks the initial stride toward enhancing analgesia/sedation practices in the NICU.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e778"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}