Use of a Standardized Review Tool with Neurodevelopment Assessment for the Infant During BPD Interdisciplinary Rounds
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Problem: Bronchopulmonary dysplasia (BPD) is the most common respiratory morbidity of prematurity, affecting nearly 10,000 infants annually, or up to 68% of those born <28 weeks gestation. Incidence rates of severe BPD, up to 21%, contribute to significant long-term respiratory and neurodevelopmental sequelae. Interdisciplinary approaches have been shown to reduce disease burden and improve outcomes. Currently, there are no published tools which include neurodevelopmental assessment, to aid interdisciplinary teams with clinical review.|Purpose: The purpose of this quality improvement project was to revise and evaluate an evidence-based standardized tool for review of infants with BPD during interdisciplinary rounds to include a neurodevelopmental (ND) focus. Methods: Two non-paired convenience samples were used. Outcome measures included team productivity, respiratory support, and ND status for 8-week periods before and after implementation of a revised data collection tool used for BPD interdisciplinary rounds at a regional children’s hospital. |Results: Fewer patient cases were discussed in BPD rounds before implementation of the tool than after (N=30 vs. 35). Ventilatory modes ranged from cannula to ventilator, including tracheostomy. The mean FiO2 (0.37±13.9, .21-.70 vs. 0.35±0.21,.21-1.0) was less with comparable tCO2 (29.3±3.4, 24-38) vs. (30.2±4.0, 18-37) after tool implementation. Both qualitative and quantitative ND tolerance and endurance values were documented for the first time following revised tool implementation.|Conclusion: The revised tool allowed for continued standardization of data collection, which included a focus on ND therapies to be used during interdisciplinary rounds, as a guiding approach to the management of care for infants with BPD.
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