Improvement in newborn care
through increased compliance with
the Neonatal Resuscitation Program:
sustaining improvement
D...
Disclosure
• I have no affiliation with any commercial or
industry interest in relation to this
presentation.
• Adele Harr...
Neonatal Resuscitation Program

3
Key Measure
• Percentage of resuscitations in which there is
accurate documentation of correctly
performed resuscitation a...
Methods
• A multidisciplinary working group of healthcare
providers who were involved in teaching and
clinical delivery of...
Planning for Success: DICE Methodology
•
•
•
•
•

Duration of project
Integrity of project team
Commitment of top manageme...
Early findings
Healthcare professionals like doing, not charting!

7
Strategy for Change
Key Drivers

Design Changes/Interventions

Knowledge/skills of
NRP

Specific Aim
Improve compliance
wi...
Quality Forum 2013

9
Newborn extended resuscitation records initiated
Percentage of records initiated

100
90
80
70
60
50
40
30
20
10
0

median...
Percentage of records completed

Correct use of pulse oximeter and oxygen documented
100
90
80
70
60
50
40
30
20
10
0

med...
Sustainability Radar Chart
Sustainability

Benefits
16

Infrastructure

Credibility of evidence
12
8

Fit with goals and c...
Key Factors in Sustainability
Strengths

Challenges

Benefits

Efficiency

Credibility of benefits

Evidence-based

Adapta...
Summary
• Visualize success

• Articulating clear goals and sharing the data
helped drive positive change

• Get everyone ...
15
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G2 - Improvement in Newborn Care through Increased Compliance with the Neonatal Resuscitation Program: Sustaining Improvement

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This presentation was delivered in session G2 of Quality Forum 2014 by:

Adele Harrison,
Neonatologist, Victoria General Hospital
Medical Director, Quality & Patient Safety, Island Health

Published in: Health & Medicine
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G2 - Improvement in Newborn Care through Increased Compliance with the Neonatal Resuscitation Program: Sustaining Improvement

  1. 1. 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
  2. 2. 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. 2
  3. 3. Neonatal Resuscitation Program 3
  4. 4. 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%. 4
  5. 5. 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 5
  6. 6. 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
  7. 7. Early findings Healthcare professionals like doing, not charting! 7
  8. 8. Strategy for Change Key Drivers Design Changes/Interventions Knowledge/skills of NRP Specific Aim Improve compliance with NRP to 100% by March 2013 Develop VIHA “program” of NRP courses Completion of Resuscitation Record Teach resuscitation record completion to NRP instructors Correct equipment available Implement checklist for resuscitation equipment Team composition Optimize team structure at deliveries Team functionality Develop recommendations for course content for different HCPs Develop multidisciplinary NRP courses 8
  9. 9. Quality Forum 2013 9
  10. 10. Newborn extended resuscitation records initiated Percentage of records initiated 100 90 80 70 60 50 40 30 20 10 0 median Percentage of records completed Newborn extended resuscitation records completed 100 90 80 70 60 50 40 30 20 10 0 10
  11. 11. Percentage of records completed Correct use of pulse oximeter and oxygen documented 100 90 80 70 60 50 40 30 20 10 0 median Percentage of records completed Correct use of pressures documented 100 90 80 70 60 50 40 30 20 10 0 11
  12. 12. Sustainability Radar Chart Sustainability Benefits 16 Infrastructure Credibility of evidence 12 8 Fit with goals and culture 4 Adaptability 0 Clinical leaders Monitoring Progress Senior leaders Involvement and training Behaviours Source: NHS Institute for Innovation and Improvement. Sustainability Model and Guide. 2010. Adapted by BC Patient Safety Quality Council 12
  13. 13. Key Factors in Sustainability Strengths Challenges Benefits Efficiency Credibility of benefits Evidence-based 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 Infrastructure Adapted environment Communication Culture 13
  14. 14. 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. 14
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