QI Pilot Project: Lengths in NICU

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QI Pilot Project Lengths in NICU
Susan Carlson MMSc, RD, CSP, LD Angela Haverly
RD, LD, Kirsten Hanrahan, ARNP, PNP, DNP Angie
Rausch, ARNP, PNP
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Background

• Measurements of growth are a good indication of
  overall well being and outcomes in infants.
• Length is a non-invasive measure of skeletal
  growth.
• Accurate measures of length are important for
  monitoring growth in infants transitioning to
  home, for high risk and primary care provider
  follow up, and infant nutrition programs (e.g.
  WIC).
• Therefore, measurement of length in stable
  pre-term and chronic infants should be as
  accurate and reliable as possible.

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Quality Issue

• Problem Measurement of infant lengths using
  paper tape measures is inaccurate and unreliable.
  
• Purpose To increase the accuracy, reliability
  and precision of length measurements in infants
  in newborn and intensive care units cared for and
  discharged from UICH.
• Striving for excellence

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Whats wrong with this picture?
This is Africa!
Length board
Picture provided by Teresa Davidson, ARNP
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Pilot Project

• Methods Evidence supports the use of length
  boards, standardized procedures, and staff
  training to increase the accuracy, reliability
  and precision of length measurements in infants.
• Personnel Lengths to be obtained by NPs and
  Dieticians. Nursing staff, residents and parents
  may assist. CRC nurses have agreed to do initial
  training and competency testing. Change will
  require teamwork and coordination of measurements
  with other cares.
• Cost
• Length Board 200 - 300 each
• Will use existing carts
• Expanding pilot to other areas (Bay 4, newborn,
  NIC 2/3) would require additional boards- pilot
  project to support the need and feasibility for
  attaining grants

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Change Forces

• Stakeholders
• Infants and families
• NICU multidisciplinary care team
• Primary Care Providers
• High Risk Infant Follow Up
• WIC

• Barriers
• Safety
• Infection control
• Storage space
• Time/coordination

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Goals- Excellence

• Increased NP knowledge, confidence, and evidence
  based techniques for obtaining lengths.
• Increased documentation of discharge lengths in
  EPIC growth chart.
• Increased number of lengths in children at risk
  for growth failure.
• Increased reliability, precision and accuracy of
  lengths measures.

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Measures

• Frequency
• Point audit- 1 day
• Discharge audit- over a month
• Accuracy/Precision
• Survey- Knowledge, attitudes and practices
• Reliability
• Repeated measures

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Reliability

• Design For each infant a length measurement will
  be performed four times, twice each by two
  experienced Nurse Practitioners.
• Procedure
• 1. NP1- Using tape measure in the envelope,
  obtain a length using standard procedure.
• 2. NP1- Reposition the child and obtain a second
  measure of the childs length using an unmarked
  tape.
• 3. Give the envelope to another nurse
  practitioner to obtain repeated length within 24
  hours.
• 4. NP 2- Using tape measure, obtain a length
  using standard procedure.
• 5. NP 2 - Reposition the child and obtain a
  second measure of the childs length using an
  unmarked tape.

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Expected Benefits

• Accurate, precise and reliable lengths
  measurements to assess growth and nutritional
  status, detect growth and stature related
  disorders and provide optimal nutrition support.

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Next steps

• Order board
• Stats consult
• Education
• Training
• Pilot standard of care
• Post-measures
• Apply for CMN grant to obtain more boards and
  roll out to NIC 1-4 and newborn (due March 22!)

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Questions?

• Contact kirsten-hanrahan_at_uiowa.edu