The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

AN ANALYSIS OF CULTURE CHANGE IN THE NICU WITH IMPLEMENETING POTENTIALLY BETTER PRACTICES: BREAKING THE STAFF'S ADDICTION TO OXYGEN

Shayne Morris1, Anita Byrd1, Heloisa Georgiev1, Johanna Villafana1



Background: As a result of the Potentially Better Practices presented by the Vermont Oxford Network, our unit decided to perform a self examination of our culture in response to two key components; oxygen alarm settings and oxygen target ranges. The aim of this study is to achieve positive culture change in the NICU environment that will reflect current potentially better practices. This project is to link a direct correlation between culture of the staff and the variability of oxygen saturations. By implementing certain measures we hypothesize to see less variability of oxygen saturations, with the potential to minimize harmful oxygen utilization. Our study is not to determine the long term effects of hyperoxia, but rather a culture change in our NICU.

Methods:
We collected oxygen saturation percentages from the Trend/ Vitals page of the patients' monitor over a period of eight hours over several weeks without staff's knowledge for dayshift and nightshift. We then analyzed the data to determine what percentage of the time the patient remained in their oxygen target ranges and alarm settings. Education of Potentially Better Practices was presented to all staff members including all nursing, respiratory, advanced nurse practitioners, and physicians. The audit was repeated over several weeks post education and analyzed.

Results:
See Table

Conclusions:
A direct correlation between the increased awareness of the harmful effects of oxygen manipulation and decreased variability of oxygen saturations was noted. A positive culture change took place by altering the staff's need to manipulate the oxygen and in doing so, they were able to optimize the patients target saturation levels.