Use of Pdsa Quality Improvement Cycle to Develop in terprofessional Oral Feeding Guidelines for Premature in fants

Abstract

Background: A preterm infant's ability to successfully oral feed is one of the final challenges that must be overcome before hospital discharge. Successful progression of feeding holds great importance for parents and their relationship with their infant. Inconsistent and delayed progression is perceived as emotionally stressful. Delayed progression to full feeding contributes to extended hospital stays and use of finite Neonatal Intensive Care Unit (NICU) resources. This quality improvement (QI) proposal focuses on one team's experience in changing from the current inconsistent process of feeding progression to the development and use of a protocol-driven stepwise feeding guideline. Objective: To improve parent and staff satisfaction with the oral feeding progression of premature infants through development of a consistent step wise process acceptable to multi-professional healthcare providers and parents in the NICU utilising the Plan-Do-Study-Act (PDSA) quality improvement cycle approach. Design/Methods: A step-wise oral feeding guideline based on the work of Glass and Wolf (University of Washington) for use in premature infants in the NICU was developed. A rapid cycle QI model was utilised to obtain iterative feedback from staff and parents/guardians to develop and trial the guideline between October 2007 and September 2009. The project was approved by local Health Research Ethics Board. Feedback mechanisms included a Likert scale questionnaire and open comments related to implementation. Frequencies of responses were calculated for the questionnaire and thematic analysis of the open comments was conducted for each of the PDSA cycles. Responses were compared between cycles for change. Demographic and feeding data was collected for a 6 month period prior to the start of the study in 2007 and again in 2009. Results: 3 PDSA cycles were conducted, with each cycle resulting in modifications to the proposed guidelines. With repeated PDSA cycles the step-wise guideline was seen to have more benefits and less negatives. Satisfaction regarding consistency in following a feeding plan and communication with other staff members and parents did not improve. Preliminary analysis revealed no differences between the preterm NICU population at the beginning and end of the study. (Table presented) Conclusions: An NICU infant feeding guideline has many stakeholders. Developing a structured framework with appropriate flexibility for the individual infant presents a challenge. A PDSA cycle approach can be used in guideline development involving interdisciplinary healthcare professionals. Frequent feedback maintains staff participation. Evidence of improved outcome may support guideline uptake. Conclusions: An NICU infant feeding guideline has many stakeholders. Developing a structured framework with appropriate flexibility for the individual infant presents a challenge. A PDSA cycle approach can be used in guideline development involving interdisciplinary healthcare professionals. Frequent feedback maintains staff participation. Evidence of improved outcome may support guideline uptake.