P2C065: Increasing Compliance with Metabolic Bone Disease Guidelines for Preterm Infants at a Level IV NICU

Purpose/Objectives: To establish a quality improvement (QI) initiative in the neonatal ICU that increases compliance with MBD guidelines (Fig.1) and improves overall bone health of preterm infants at risk for metabolic bone disease.

Design/Methods: All preterm infants < 32 weeks gestational age admitted to the level IV NICU from Jan 2022-Feb 2023 were included. To track and record compliance with already established evidence based MBD screening guidelines, baseline data was collected; specifically, time to primary screen draw and whether an appropriate endocrine consult was placed. The interdisciplinary team aimed to increase compliance with guidelines by targeting 4 key drivers (fig. 2) including alignment of multidisciplinary team, optimization of evidence-based nutrition and MBD guidelines, appropriate consultation of endocrinology and standardizing ordering practices. Data is tracked on a monthly basis using a statistical control chart.

Results: 109 preterm infants who met criteria for MBD screening were reviewed. The centerline mean for compliance with MBD guidelines for primary screen was 72%. Data showed only 73% of the staff appropriately consulted endocrinology. Only 25% of infants triggered a secondary screen. Only 7 out of 27 infants (26%) that triggered a secondary screen did not meet criteria, leading to unnecessary blood draws in the setting of obtaining an erroneous secondary screen or obtaining an early primary screen.

Conclusion/Discussion: A NICU-based QI initiative focused on increasing compliance with MBD guidelines to promote preterm infant bone health and avoid unnecessary blood draws requires multidisciplinary input. With improved compliance with MBD guidelines, we aim to decrease the percentage of inappropriate blood draws and endocrinology consults. A more focused approach targeting appropriate phosphorus and calcium supplementation is underway, with nutrition and endocrine collaboration. Continued direct feedback to providers when unnecessary blood draws are taken remains crucial.