Improvement in newborn care through increased compliance with

the Neonatal Resuscitation Program: sustaining improvement

Dr Adele Harrison; Island Health Jessica Belle, Shaun van Pel, Ashley

Jewett; Island Medical Program

Disclosure

• I have no affiliation with any commercial or industry interest in relation to this presentation.

• Adele Harrison is a Neonatal Resuscitation Program (NRP) instructor and regional instructor-trainer.

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Neonatal Resuscitation Program

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Key Measure

• Percentage of resuscitations in which there is accurate documentation of correctly performed resuscitation as characterized by correct use of oxygen and correct use of ventilation pressures according to NRP.

• Target: 100%.

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Methods

• A multidisciplinary working group of healthcare providers who were involved in teaching and clinical delivery of NRP was established.

• Hospital charts of up to 5 newborns admitted to the Neonatal Intensive Care Unit were audited every 2 weeks from April 2012 to May 2013 and from November 2013 to February 2014.

• Plan-Do-Study-Act cycles were utilized to evaluate change ideas

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Planning for Success: DICE Methodology

• Duration of project • Integrity of project team • Commitment of top management • Commitment of employees affected • Effort over and above usual work

– DICE Score =12 “Win Zone” (7 to 14)

Hal Sirkin, Perry Keenan and Alan Jackson. The Hard Side of Change Management, October 2005, Harvard Business Review . 6

Early findings

Healthcare professionals like doing, not charting!

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Completion of Resuscitation Record

Correct equipment available

Team composition

Knowledge/skills of NRP

Improve compliance with NRP to 100% by

March 2013

Specific Aim

Key Drivers

Teach resuscitation record completion to NRP instructors

Develop multidisciplinary NRP courses

Develop VIHA “program” of NRP courses

Develop recommendations for course content for different HCPs

Implement checklist for resuscitation equipment

Design Changes/Interventions

Optimize team structure at deliveries

Strategy for Change

Team functionality

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Quality Forum 2013

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Newborn extended resuscitation records completed

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Newborn extended resuscitation records initiated

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Correct use of pulse oximeter and oxygen documented

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Correct use of pressures documented

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median

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16Benefits

Credibility of evidence

Adaptability

Monitoring Progress

Involvement and training

Behaviours

Senior leaders

Clinical leaders

Fit with goals and culture

Infrastructure

Sustainability

Sustainability Radar Chart

Source: NHS Institute for Innovation and Improvement. Sustainability Model and Guide. 2010. Adapted by BC Patient Safety Quality Council

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Key Factors in Sustainability Strengths Challenges

Benefits Efficiency

Credibility of benefits Evidence-based Communication

Adaptability of process System change

Ability to monitor progress Ongoing

Staff involvement/training From the beginning

Behaviours towards change Some buy-in QI not part of the culture

Senior leadership support Engaged Not visible

Clinical leadership support Engaged and involved

Strategic aims and culture Clear goals Culture

Infrastructure Adapted environment

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Summary

• Visualize success • Articulating clear goals and sharing the data

helped drive positive change • Get everyone on board

• Including multidisciplinary clinical staff in the process positively impacted sustainable change.

• Make it child’s play • Environmental modifications and system changes

were powerful drivers of behaviour and promote sustainability.

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