Improving Preterm Infants' Oxygen Saturation Target Time: A Quality Improvement Initiative

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)

Kayla Short (Creator)

Institution

The University of North Carolina at Greensboro (UNCG )

Web Site: http://library.uncg.edu/

Advisor

Crystal Epstein

Abstract: Background: Preterm infants born before 32 weeks’ gestation are at especially high risk of theharmful effects of supplemental oxygen received after birth. A fine balance exists betweenprovision of too much or too little oxygen support. The Neonatal Oxygenation Prospective Meta-analysis (NeOProM) Collaboration recommends oxygen saturation targets of 90-95%. Oxygensaturation histograms are a non-invasive way to monitor oxygen saturation data for preterminfants receiving supplemental oxygen in the neonatal intensive care unit (NICU) and canfacilitate compliance with recommended oxygen saturation targets.Purpose: The purpose of this quality improvement initiative was to 1) educate bedside staff in alevel IV NICU about oxygen saturation targets based on recommendations from the Committeeon Fetus and Newborn and NeOProM, and 2) to increase the amount of time preterm infantsspend within their ordered oxygen saturation target.Methods: Five total cycles of education and data collection were performed. Data collectioninvolved evaluating histograms for time preterm infants less than 32 weeks’ gestation spentbelow (<90%), within (90% - 95%), and above (>95%) their ordered oxygen saturation target.Education sessions reinforced the current unit protocol of oxygen saturation targeting of 90-95%for preterm infants less than 32 weeks’ gestation.Results: At baseline, preterm infants were within their target oxygen saturation range 32% of a24-hour period, or approximately 7.7 hours. This time increased to 45% of a 24-hour period(approximately 10.8 hours) during cycle 3 but returned to baseline at 32% of a 24-hour periodduring cycle 4. Overall, preterm infants were within their target oxygen saturation range 37% ofa 24-hour period, which is a 5% increase over baseline, equivalent to an additional 1.2 hoursspent within target range.Recommendations and Conclusions: Overall, the project was successful in increasing theamount of time spent within the range by an additional 1.2 hours per day, on average. Oxygensaturation histograms are helpful tools for assessing compliance with narrow oxygen saturationtargets. Ongoing evaluation of oxygen saturation histograms is recommended for continuedcompliance with narrow oxygen saturation targets and overall improvement in provision ofappropriate supplemental oxygen. Effects of education may not be retained over time. Moretargeted education of newer nursing and respiratory therapy staff may be warranted. Routineaudits of oxygen saturation monitor alarm settings is another tool that could be used to ensureappropriate targeting of oxygen saturations for preterm infants.

Improving Preterm Infants' Oxygen Saturation Target Time: A Quality Improvement Initiative
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Created on 6/25/2024
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Additional Information

Publication

Other

Language: English

Date: 2024

Keywords

oxygen saturation, oxygen saturation targeting, oxygen saturation goals, oxygen saturation limits, oxygen saturation histograms, oxygen histogram monitoring, neonatal intensive care unit, preterm infants, retinopathy of prematurity

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