Quality Improvement of Nasal Continuous Positive Airway Pressure Therapy in Neonatal Intensive Care Unit

• Published in: Pediatrics and neonatology Vol. 58; no. 3; pp. 229 - 235
• Main Authors: Chen, Chien-Yi, M.D., PhD, Chou, An-Kuo, M.D, Chen, Yu-Lien, RN, Chou, Hung-Chieh, M.D., PhD, Tsao, Po-Nien, M.D., PhD, Hsieh, Wu-Shiun, M.D
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier 01.06.2017
• Subjects: Clinical Competence; Clinical Protocols; Continuous Positive Airway Pressure - adverse effects; Continuous Positive Airway Pressure - standards; Education, Medical, Continuing; Education, Nursing, Continuing; Female; Follow-Up Studies; Humans; Infant, Newborn; infants; Intensive Care Units, Neonatal - standards; Intensive Care, Neonatal - standards; Internal Medicine; Male; nasal continuous positive airway pressure; nasal trauma; Neonatal Nursing - education; Neonatology - education; Nose - injuries; Pediatrics; protocol; Quality Improvement - statistics & numerical data; Taiwan; Time Factors; NCPAP; protocol; infants; nasal trauma; nasal continuous positive airway pressure
• ISSN: 1875-9572; 2212-1692
• DOI: 10.1016/j.pedneo.2016.04.005

Abstract Background Nasal continuous positive airway pressure (NCPAP) therapy is widely used in neonates but the clinical practice varies. However, nursing practice differs among individuals, and inappropriate application method may delay the respiratory therapy, influence the beneficial effect and increase the complications. We introduced a quality improvement project to expedite the application of NCPAP therapy, and decrease the incidence of nasal trauma. Methods A new strategy of mobile NCPAP cart with pre-packed fixation kit and written protocol was implemented from April 2006. All medical staff answered a questionnaire to assess the basic knowledge before and after intensive training. The records of the patients who were treated with NCPAP from October 2005 to November 2006 were reviewed. Results Fifty-nine medical staff were involved in the project, and their mean score for the questionnaire improved from 69.2 to 98.3 points after training. From October 2005 to November 2006, 113 infants were recruited in total and 82 of them were admitted after the protocol was implemented. The NCPAP cart dramatically shortened the preparation (from 520 to 72 seconds) and application time (from 468 to 200 seconds). Use of the nursing protocol significantly decreased the incidence of nasal trauma in the study population (45.2% vs. 19.6%, P = .006), but not in infants with birth weight <1000 g. Risk factors for nasal skin trauma included lower gestational age and birth weight, longer duration of NCPAP use, and lack of standardized nursing care. Conclusions The mobile NCPAP cart with pre-packed fixation kits is a practical way to expedite the initiation of NCPAP therapy. Written nursing protocol decreased the incidence of nasal trauma in infants, except for those with extremely low birth weight.