P2C064: Quality Improvement to Reduce Chronic Lung Disease Rates in Infants < 30wk Gestational Age: Persistence, Patience and High Compliance Using a Respiratory Care Bundle

Purpose/Objectives: Bronchopulmonary dysplasia (BPD) remains the most common complication of preterm births affecting approximately 50% of infants born < 1kg. BPD increases the risk of early childhood mortality, neurodevelopmental delay, and chronic respiratory impairments. Neonatal respiratory care is complex with significant variability amongst providers and institutions, which could explain the wide prevalence of BPD. BPD may be amenable to quality improvement (QI) efforts.

Design/Methods: A respiratory committee team consisting of physicians, advanced practice providers, nurses, respiratory, physical, occupational and speech therapist was formed at our hospital in 2017. Using current literature, potentially better practices and other NICU bundles, the team developed drivers for change. The respiratory care bundle was intended to streamline the care of premature infants by encouraging non-invasive ventilation, surfactant administration using the INSURE approach and reducing ventilator days/volutrauma through use of volume targeted ventilation. By implementing these changes, the targeted outcome of reducing the incidence of chronic lung disease and other cardiopulmonary/neurologic sequelae resulting from exposure to prolonged positive pressure ventilation was expected. The respiratory committee team collected and reviewed baseline data of infants < 30-weeks gestational age from 2017-2021. Our SMART aim was to decrease BPD rate by 8% by January 1st, 2023, after making very little progress with improving BPD rates from 2018-2021. This project began in 2017 and was revised with multiple PDSA cycles to ensure streamlined approaches were implemented in real time to optimize patient care outcomes.

Results: In 2022 we managed a total of 70 patients born at less than 30-weeks gestational age. Demographics remained similar between 2018-2022 (see attachment). We demonstrated a 11.7% decrease in our BPD rate in comparison to 2021 data. Of these 70 patients, our incidence of BPD decreased to 27.1%. In comparison, our BPD rate was 38.8% in 2021, 33.3% in 2020 and 2019 and 35.1% in 2018.

Conclusion/Discussion: Implementing and revising a multidisciplinary respiratory care bundle with persistent re-education decreased our BPD rates in preterm infants less than 30-weeks gestational age by 11.7% in 2022. By establishing and maintaining a respiratory care bundle with focus on multi-disciplinary education, aggressive respiratory support weaning strategies, feeding advancement protocols, infection prevention measures and avoidance of volutrauma and hyperoxia; we have demonstrated improvements in our BPD rate in 2022. Our room air challenge protocol will further differentiate our true incidence of BPD versus oxygen needs for ROP management. Our future direction in 2024 to further reduce BPD rates will be to implement less invasive
surfactant administration (LISA) techniques. In conclusion, we demonstrated that although BPD remains the most common, stubbornly persistent morbidity of prematurity, continued dedication to quality improvement using a respiratory care bundle has proven impactful in reducing BPD.