2012 OPEN FORUM Abstracts
STANDARDIZED OXYGEN WEANING CHALLENGE IN NEONATAL INTENSIVE CARE UNIT.
Hratch Kayichian; Respiratory Therapy, RRUCLA Medical Center, Los Angeles, CA
Background: Several advances in technology have aided babies who require oxygen (O2) support in neonatal intensive care units (NICUs). However, timing and weaning off oxygen varies across sites. There is a paucity of evidence to standardize O2 weaning for NICU patients on nasal cannula (NC O2). This quality assurance (QA) initiative is aimed at using a standardized Oxygen Weaning Challenge (OWC) for eligible infants who remain on conventional NC O2 < 30% and with O2 saturations > 90% at 28 days of life (DOL) or 36 weeks gestational age (GA). The OWC offers a step-wise structured method to assess vital signs, respiratory effort, and O2 saturation to better document and define each patients tolerance and their outcome (Pass or Fail). Methods: This QA project included a multi-disciplinary team that proposed to translate research into clinical practice. This observational study examined a hospital based cohort starting with a needs assessment describing the complexity and respiratory needs of infants admitted between January 2011 and January 2012 (n= 599). The OWC was utilized to assess readiness to wean O2. Staff education on OWC was provided via committee meetings, emails and huddles. A convenience sample of staff (n=60) was surveyed regarding awareness and benefits of OWC, the importance of O2 weaning and comfort levels of communicating O2 needs to RTs. Analyses included descriptive statistics and cross tabulations. Results: We identified 69 infants (12%) on O2 DOL 28 or 36 weeks GA. The majority were male (73%), >32 weeks GA at birth (57%), > 1.5 kg birth weight (65%), on O2 at delivery (70%) and received antenatal steroids (50%). Most were on ventilator support > 4 days (75%) and hospitalized in NICU > 60 days (75%). Many had congenital birth defects requiring either heart surgery (24%) and/or GI surgery (24%). Ten were OWC tested with a 60% pass rate. Of the 55 clinicians who returned the survey (91%), the majority (85%) reported the OWC was very beneficial to care for eligible stable infants. Most (80%) reported being very comfortable regarding OWC communication with RTs and 86% reported a structured O2 wean was very important. However, only 22% were very familiar with the OWC. Conclusions: These findings suggest we need ongoing promotion and evaluation of the utility of the OWC as a NICU standard of practice within our vulnerable infant population. Sponsored Research - None