P2D196: Improving Plagiocephaly Anticipatory Guidance in the Pediatric Primary Care Clinic

Purpose/Objectives: The aim of this study is to increase Plagiocephaly Anticipatory Guidance to 50% in all infants presenting for their initial newborn visit through the 6- month Health Maintenance visit in Monday Continuity Clinic within 4 months

Design/Methods: Baseline data on Plagiocephaly Anticipatory Guidance was collected between May 2022 and August 2022. During the study period, charts were reviewed from September to December 2022 and 3 PDSA cycles were conducted with the following measures: Outcome measure: percent of infants presenting for the initial newborn visit through the 6 month Health Maintenance visit who were provided Plagiocephaly Anticipatory Guidance. Process Measure: the use of a dot phrase for anticipatory guidance attendance at lecture and Balancing Measure: referral to specialists.
In PDSA 1, an educational lecture was given to providers and a patient educational hand out ( image 1) including pictures were created in our EMR and was available in 4 of the most common languages spoken by our patients ( English, Spanish, Bangla and Nepali). PDSA cycle 2 involved email reminders to providers and PDSA cycle 3 included posting the Educational hand out in a common area for the providers as a visual reminder.

Results: Baseline data showed there were 2/50 ( 4%) patients between newborn and 6 months age with plagiocephaly identified. 8/50 (16%) were provided with no plagiocephaly anticipatory guidance and the remaining with partial anticipatory guidance(tummy time only). 2 (4%) were referred to specialists at the 6 month visit and none were prescribed helmets. 303 patients were seen during the study period. After the completion of 3 PDSA cycles, a total of 69% ( 209) patients received complete anticipatory guidance on plagiocephaly. ( figure 3 -Run chart) . We did not refer any patients to specialists for evaluation. We also noted during the study period, 6 (2%) patients were diagnosed with plagiocephaly, showing a decreased incidence of positional plagiocephaly compared to baseline. None of the 6 patients with plagiocephaly were prescribed helmets.

Conclusion/Discussion: Through our Quality Improvement project aimed at increasing Plagiocephaly Anticipatory Guidance we were able to improve patient education to infants presenting for their initial newborn visit through the 6 month Health Maintenance visit. We also noted a decrease in the diagnosis of plagiocephaly and number of referrals to specialists. Providing detailed plagiocephaly anticipatory guidance should be emphasized early.