A quality improvement project improving the value of iNO utilization in preterm and term infants

• Published in: Journal of perinatology Vol. 41; no. 1; pp. 164 - 172
• Main Authors: Fischer, Hannah, Singh, Tamina, Devlin, Lori, Obi, Olugbemisola, Robinson, Tonya, Schultz, Seth, Telang, Sucheta, Duncan, Scott
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.01.2021; Nature Publishing Group
• Subjects: 692/700/1720; 692/700/3934; Automation; Clinical trials; Dosage and administration; Drug therapy; Infants; Medicine; Medicine & Public Health; Neonatal intensive care; Newborn babies; Nitric oxide; Nurses; Nursing; Pediatric research; Pediatric Surgery; Pediatrics; Population; Premature birth; Project design; Quality control; Quality improvement; Quality Improvement Article; Quality management; Respiratory failure; Respiratory insufficiency; Respiratory therapy; Weaning; United States
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-020-0768-0

Objective Inhaled NO (iNO) is used in the NICU for management of hypoxemic respiratory failure. The cost of iNO is significant and does not consistently improve outcomes in infants <34 weeks. Project design Our team used The Model for Improvement to design a quality improvement project to utilize iNO for appropriate indications, ensure response to therapy and initiate timely weaning. The project was carried out at a Level IV NICU and successful interventions spread to a smaller Level III NICU. Results This project demonstrated significant improvement in all measures; total iNO hours per month, average iNO hours per patient, and the percentage of prolonged iNO courses. With an estimated cost of $115/h, the cost per patient for iNO use declined by half from $21,620 to $10,580. Conclusions Our team improved the value of iNO utilization at our institution and spread successful interventions to another NICU in our network.