BACKGROUND: Early detection of retinopathy of prematurity (ROP) in premature infants is crucial to prevent blindness. Adherence to screening guidelines may be problematic in high-risk populations. Continuous Quality Improvement (CQI) calls for formulating best practices to influence clinical decision-making, changing processes to deliver these practices and using data to improve processes. PURPOSE: The purpose of this study was to utilize CQI to increase timely ROP screenings in a neonatal intensive care unit. METHODS: Based on retrospective chart review showing 76% adherence to national screening guidelines, the ROP clinical protocol was selected for CQI. A multidisciplinary team met to formulate best practices for screening eligible patients. The team modified clinical protocol to include documenting when the exam should take place in patient records. Preliminary audit of documentation indicated 20% adherence to the new protocol. Staff received training to complete specific tasks to follow the protocol. Subsequent quarterly chart audits examined documentation of forms and receipt of screening. RESULTS: The CQI cycle resulted in revised clinical protocol which clarified staff roles and mandated use of a form to document screening date. Post-intervention audits showed that 94% of forms were used correctly and that 97% of eligible infants received timely screening. These clinically and statistically significant gains (p<0.01) remained at one-year. A time trend of clinical protocol adherence from 1997 through 2000 will be available at presentation. CONCLUSION: CQI can identify problems in clinical process, lead to more effective clinical protocol, and improve the quality of preventive medicine for neonatal intensive care patients.
Learning Objectives: Learning Objectives: 1. Recognize how continuous quality improvement principles can apply to a neonatal intensive care unit population. 2. Describe the process involved to determine what changes to make in clinical protocol. 3. Describe how to measure and continually evaluate the improvement
Keywords: Performance Measurement, Neonatal Screening
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.