Translating Quality Improvement to the Bedside Provider by Using in Unit Based Team Leads

Abstract

Background: Texas Children’s Hospital (TCH) is located in Houston, Texas. The TCH Newborn Center has 173 beds separated into three units. The Newborn Center is staffed with 480 registered nurses (RNs), 130 physicians and neonatal nurse practitioners (NNPs), and 50 respiratory therapists (RTs). The task of translating quality improvement (QI) projects related to reducing lung injury from teams to the providers at the bedside is a daunting prospect and one that we struggled with based on having three separate units and such a large staff. Methods: The Respiratory Care Department made a commitment to pilot providing Team Leads (TLs) Monday through Friday on the day shift, and Monday through Thursday on the night shift. The TLs were then integrated into the Avoiding Lung Injury (ALI) QI Team which had a focus on minimizing time on the ventilator, a CPAP first strategy, placement of CPAP on in the delivery room, oxygen titration and performing room air trials on qualified infants. The TLs are also engaged with simulation related to decreasing unplanned extubations, performing skin rounds and providing respiratory education to the nursing staff, physicians and NNPs. The TLs attend the morning huddles and report out to the medical teams on infants that are on extubateable settings, infants that are on inhaled nitric oxide and infants that have not had their supplemental oxygen weaned in a week. Monthly educational topics are developed and the TLs will take the education to the bedside for nursing and medical staff. Results: Placement of CPAP in the delivery room is at 100%, there have been no serious hospital acquired skin injuries, and the unplanned extubation rate is at a new low of 0.4 events per 100 ventilator days. The culture is shifting in that there are now extubations occurring around the clock and not primarily on the day shift Monday through Friday as was the old routine. The TLs have been able to provide ventilator education to incoming classes of Graduate Nurses and to incoming Fellows and Residents. Conclusions: The TLs have had a positive impact on the Newborn Center and are actively engaged in seeking out additional opportunities in which they can get involved. The next step will be to place a cost value to the role so that hospital administration can see the value in having a non-productive, meaning not generating revenue via therapy, positions in the Respiratory Care Department.