Improving Delivery of Positive Pressure Ventilation During Neonatal Resuscitation: A Quality Improvement Study

Abstract

Background Positive pressure ventilation (PPV) is one of the most crucial steps of the Neonatal Resuscitation Program (NRP) algorithm. We observed multiple deviations from NRP algorithm during PPV delivery in our unit for which we planned a quality improvement (QI) initiative. The aim of this study was to improve PPV score (total score 14) from existing 20% (~3) to at least 60% (~8) during neonatal resuscitation in delivery room and maternity OT over a period of 48 weeks. Methods The study was conducted in 3 phases over a period of 48 weeks. The baseline and the sustenance phase were of 12 weeks and the intervention phase consisting of 4 PDSA cycles was of 24 weeks duration. Several change ideas were tested and implemented during these PDSA cycles including training sessions for effective PPV delivery, ensuring adequate number of personnel attending delivery and equipment check, specification of delivery team at the start of a shift, and involvement of obstetrics colleagues for better communication. The objective scoring of PPV (a total composite score of 14 over 7 domains) was taken as the process measure, while the proportion of deliveries with PPV score >60% (~8) and need for alternate airway were the outcome measures. We used statistical process control (SPC) Xbar mean chart and P charts for analyzing the data. Results The median score during the baseline phase was 20% (3/14) which improved to 71% (10/14) during the sustenance phase. The percentage of deliveries having a score of at least 60% (8/14) also improved significantly from the baseline to the sustenance phase; there was, however, no change in the need for alternate airway. Conclusion This QI study successfully improved the PPV delivery practices. Similar studies involving multiple centers and including other steps of NRP algorithm should be undertaken for the overall betterment of neonatal care and outcomes. What Is Known NRP is an evidence-based approach for neonatal resuscitation; however, evidence suggests that the quality and sequence of events during neonatal resuscitation significantly deviate from the standard guidelines. What This Study Adds QI is an excellent tool to improve the adherence to PPV delivery during newborn resuscitation. Along with training and teaching of the care giving staff, the study identified important gaps in PPV delivery which were solved using simple and comprehensive measures.