b'QUALITY INITIATIVES IMPROVE NICU CARE. This team follows a strict two-person process: One nurse performs all tasks that need to be sterile, such as changing caps, while the second nurse does all non-sterile tasks, such as Central line-associated blood stream infections (CLABSIs), unplanned extubations (UEs) andopening the incubator. increased opioid use are just some of the many challenges faced by critically ill patients in neonatal ICUs across the country. At the Level IV NICU at Childrens Health Childrens MedicalThis has been a huge success, says Lisa Wulz, RN, who manages our neonatal-perinatal Center Dallas, we are committed to tackling these challenges as we strive to provide the bestquality improvement programs. Before creating this team, our rate was 1.7 infections per 1,000 care for our patients and their families.line daysand now its down to and stays at 0.3. Weve made significant strides in these areas, thanks to a culture that encourages every teamPREVENTING UNPLANNED EXTUBATIONS IN THE NICU.memberfrom nurses to physiciansto ask hard questions and lead the search for answers.Babies that experience unplanned extubations can have complications such as airway trauma, Quality improvement methodology involves a rigorous, data-driven evaluation of processescode events, hypoxia and increased length of stay. These can be especially hard to prevent that are continually measured, refined and then sustained in an attempt to deliver the bestin small, critically ill neonates. Nationally, NICUs average approximately one UE for every 100 care to our patients. Our quality initiatives have helped us achieve many things, like makingventilator days. The rate in our NICU is currently around half the national average, thanks our central line infection rates among the best within level IV NICUs across the nation,to a series of new practices. These include a standardized method of securing our tubes, a says Vedanta Dariya, M.D., neonatologist at Childrens Health and Assistant Professor at UTrigorously enforced team approach to moving intubated babies and daily discussions of tube Southwestern. Were eager to share our solutions and collaborate with other centers to makeposition on medical rounds. care even better. Our rates first started coming down when we standardized the method of securing the A TEAM APPROACH TO PREVENTING INFECTIONS. endotracheal tubes in all patients, says Whitney Lewis, BSN, RN, CPN, clinical manager of the NICU. It solves the problem of having tape come loose because of oral secretions.CLABSIs are often at highest risk of occurring at the time of dressing changes. The traditional approach to care of the central line involved the bedside nurse changing the dressing forOur team also posts signs to indicate which patients have a higher UE risk, such as babies who their own patients. We were part of a large, national trial that showed significantly improvedweigh under 1,000 grams or those with a history of a previous UE. And whenever a baby is outcomes when a select team of nurses is responsible for the care of all central lines. Wemoved, two nurses are assigned to the jobone to move the child and one to manage the tube. were quick to adapt our staffing needs to provide the support needed to meet theseWeve also taken extra steps to minimize UE risk during kangaroo care.recommendationsthats how our BSI team was born. Our team fits the parent with a cushioned device that keeps the baby in position, andWhitney Lewis, BSN, RN, CPN, contributes to ongoingwe provide a handout for parents with instructions such as not using their phones while quality improvements as a NICU Nurse Manager. holding their child, Whitney says. Parents having direct contact with their babies is so important, we do everything we can to enable it while protecting their airway and keeping the babies intubated. REDUCING OPIOID USE IN THE NICU.Adequate pain control during painful procedures is beneficial to the developing nervous system of the newborn. However, medical opioid use has increased in NICUs across the country and carries risks for patients. We recently launched a quality improvement initiative to strike the balance between adequate pain control and decreased opioid use for our patients after surgery. As part of this, one of our NICU nurse practitioners developed a clinical algorithm that guides the team through an objectively determined evaluation of pain and strictly monitored pharmacological and non-pharmacological support after minor surgeries.With the help of this tool, we have a pain management plan before the baby leaves the operating room, Whitney says. Its another way were standardizing pain management and avoiding opioids unless theyre absolutely necessary, says Lebanon David, who developed the tool based on practices and results from other childrens hospitals as part of a large national, multi-center initiative through the Childrens Hospitals Neonatal Consortium.'