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Welcome To

NICU Protocols

Bringing Healthcare Quality and Safety to the

bedside of every patient by reducing variation in care. Standardizing neonatal care by providing evidence

based clinical management algorithms to the front-line clinicians.

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Introduction

Dear Friends and Colleagues

Every hospital is different, and every unit has specific needs. However, the available evidence provided to us from many fantastic clinical trials and basic research is the same and should be the basis for clinical care. If a person is having a heart attack, they should be getting the same care in hospital in London as they would get in a hospital in San Diego. Similarly, there are many aspects of neonatal ICU care that is backed by very strong evidence. These treatments should be a provided in every NICU and it should in many ways be the patients right to receive the standard of care. This standard of care should also serve as a source for what is considered good quality care. It appears that suggesting a way to standardize care is not welcomed even though it is known that standardizing care and reducing variation of care improves quality of care, outcomes and makes the healthcare delivery safer. This website can be used as a blueprint for how to provide a strong quality and safety culture in your unit, optimize workflow, improve provider satisfaction, improve outcomes by consistently providing evidence-based care at every bedside.

Everyone who works in healthcare are passionate and they want to do a good job. We want to provide excellent healing care to our patients in a caring and compassionate way. Patients need care and deserve care 24/7. As healthcare workers we are always on and in our changing healthcare system that means we are always continuously monitored and evaluated. Many healthcare workers feel that our professions in general are subject to a negative and frequently punitive tone. The famous ABC’s of medicine, accuse, blame and criticize can unfortunately still be found in many institutions and units. With the additional changes related to documentation demand, billing, frequent technology changes, the rising cost of healthcare and the financial pressures even restraints frequently influencing the healthcare providers in their day-to-day work has made it such that many healthcare workers wish to leave their profession.

Quality improvement and health care safety to many feels like it has been forced upon clinicians and the perception is that I even interfere with the front-line work. Quality improvement projects unfortunately often falls in the hands of the wrong people, people who seek to gain control of projects through micromanaging and not people who seek to bring the power to the individual providers by sharing the “why” and developing an exciting vision for everyone to share and work towards.

 

We want to demystify quality improvement work and bring it to the fingertips of every clinical provider to incorporate into every day clinical work. All aspects of this overview are interconnected and ultimately ties into how to incorporate high level quality and safety focus in the unit for every patient encounter. The text is divided in a way that can function as a blueprint for establishing a very strong quality and safety infrastructure in your unit.

Process improvement refers to the infrastructure in the unit that is aimed at driving quality such as processes, order sets, protocols even updated phone directory.

Performance improvement addresses how well are people utilizing the processes set in place in the unit and addressing needs for developing new processes. Many of the terms associated with quality improvement are related to performance improvement, such as PDSA cycle, lean, Kaizen etc.

High Reliability is a state based on a developed and shared culture of embracing the processes aimed at improving quality and safety as well as using performance improvement tools to constantly and consistently improve based on obtained data.

We can do this – taking charge of our profession all while improving care, spending more time at the bedside and lowering cost.

Understanding Quality Improvement

Quality and safety initiatives in healthcare often hide behind poorly defined terminology that seem intimidating, restrictive or controlling.However, establishing a strong quality infrastructure will increase clinical control, improve care, reduce errors and provide more freedom for the clinician to engage with patient care at the bedside. Integrating evidence-based medicine into the day-to-day clinical care of patients should be the minimum of expectation and individualized patient medical and personal

Winding Forest Road

needs can be addressed on top of evidence-based care. Medical management in the NICU is complex and standardizing clinical care based on evidence is daunting but possible. Reducing variation in care optimizes and elevates the quality of care and reduces the risk of medical errors. Every effort should be made to reduce the variation in care.

There is a focus on standardizing clinical management of defined diseases (such as RDS and hypoglycemia) but also focus on preventive management (reducing the risk of NEC, BPD and invasive infection).

This will give every NICU a blueprint of how to develop a strong evidence-based infrastructure and by doing this creating a process-oriented Architecture.

 

Most quality and safety experience and terminology has been derived from engineering, production and the aviation industry. Just imagine if there was no process at airports of checking in to get your boarding pass, checking your bags, going through TSA or boarding the plane. Also, no process for pilots to go through pre-flight check lists, check the fuel, getting the right luggage to the right plane, check in with the tower using understandable terminology and being guided to the right runway for takeoff. Imagine all the points where something could get missed and how chaotic and dangerous it would be to fly if the aviation industry did not function under strict protocols and processes. There are almost 10,000 planes in the air at any given time carrying over 1 million passengers. For each one of these 10,000 planes similar guidelines have been followed for each flight all over the world. Looking at a flight map of the world, with each one having multiple processes, check lists and protocols you are looking at a process ecosystem.

What We Do?

We provide evidence-based clinical guidelines in form of protocols, checklists, and processes.

We provide education on how to become a highly reliable and high-performing NICU.

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