Transcript Background - Loyola Medicine

Oxygen With Love: Reducing
Complications of Oxygen
Administration in Preterm Infants
Team Members
Marianne Chybik, APN/CCNS, Neonatal Case Manager
Pat Hummel, APN/CNNP, Neonatal Nurse Practioner
Elaine Trulis RN, BSN, Nurse Manager, NICU
Jeanette Cronin RNC, BSN, Barb Hering, RNC, MSN &
Joanne Kurek RNC, BSN, NICU Staff Nurses
Marc Weiss, MD, Director of Neonatology
Background:
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Oxygen With Love
Oxygen is a commonly administered drug in the
Neonatal Intensive Care Unit
Oxygen is vital to survival, but also has toxic effects in
the premature infant, such as contributing in the
development of Retinopathy of Prematurity (ROP)
Recent research has demonstrated that the incidence
of severe ROP may be reduced by maintaining the
premature infant’s oxygen saturation levels (SaO2)
within lower, controlled, specific ranges
Problem statement
Oxygen With Love
Retinopathy Of Prematurity is a
common complication of prematurity
associated with high levels of oxygen
administration. Baseline data indicates
that at Loyola’s NICU, premature infants
are within the correct oxygen saturation
range 33% of the time.
Contributing Causes
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Oxygen With Love
Lack of awareness of current best
practice guidelines
Difficulty in maintaining SaO2 within
tight control at all times – intensive
surveillance at bedside is required, with
frequent adjustments in percentage of
oxygen administered
GOAL:
Oxygen With Love
Oxygen saturation levels are
within the ordered saturation range
75 % of the time for the target
population, which includes all
premature infants receiving oxygen,
weighing less than 1500 grams (3 lbs
5 oz)
Solutions Implemented
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Oxygen With Love
Participation in Tufts Medical Center NOPOP
survey (Nursing Opinions and Practices for
Oxygenation in Prematures)
Multidisciplinary staff education: nursing,
respiratory, and medical from January - April
2005 “Oxygen is a Toxic Drug”
Seemore the OWL (Oxygen With Love) cards at
each bedside with ordered SaO2 range
SaO2 ranges added to EPIC admission order
sets
Follow up evaluations at 6 and 12 months
Results:
DRAMATIC Improvement in
maintaining oxygen saturations
within tight controls
Oxygen With Love
100%
saturations within
or below ordered
range
75%
50%
saturations above
ordered range
25%
0%
Oct-Dec
2004
JuneAugust
2005
Jan-06
Recommendations for
Further Action
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Oxygen With Love
Monthly chart review to evaluate continued compliance
with ordered oxygen saturation levels
EPIC SaO2 orders and Seemore the OWL cards have
been incorporated into practice.
The original in-service presented to all staff “Oxygen
is a Toxic Drug” is incorporated into nursing
orientation in the NICU.
Follow laser ablation intervention to assess impact of
current changes in practice in infants with ROP
(Retinopathy of prematurity)
Oxygen With Love
Seemore the Owl says
“Be an OWL (Oxygen With Love) kind of person!”
My OWL sat range is 85 – 92% since I am less than 28 weeks
gestation.
**Keep my oxygen saturation alarm limits set at 80 – 95%
and wean my oxygen as needed**
Seemore the Owl says
“Be an OWL (Oxygen With Love) kind of person!”
My OWL sat range is 90 – 95% since I am 28 – 34 weeks gestation.
**Keep my oxygen saturation alarm limits set at 85 – 98%
and wean my oxygen as needed**