Authors (including presenting author) :
Luk CY, Cheung SF, Kwok HY, Lee HC, Ng TK, Chiu GS, Cheung SC, Wong KY
Affiliation :
Department of Paediatric and Adolescent, Queen Mary Hospital
Introduction :
Oxygen is the most frequently administered medication in NICU. However, individualised oxygen delivery is crucial to prevent adverse outcomes. Despite its recognized importance, global compliance with oxygen targets remains suboptimal. In 2024, our 17-beds NICU in Hong Kong achieved only 54.7% of the target oxygen saturation based on neonatal clinical conditions. Consequently, a quality improvement initiative was undertaken to enhance the optimal oxygen saturation rate.
Objectives :
(1) to increase the duration of time neonates spent within the target oxygen saturation range by 20% and reduce the time spent in the hyperoxia range; (2) to attain the accuracy of the alarm limit setting practice to over 80%
Methodology :
We utilized a pretest-posttest design and employed the PDSA model as the project framework. Neonates hospitalized in NICU requiring oxygen with FiO2 > 0.21 were recruited. Outcome measures included: (1) the percentage of time spent within the target saturation range, assessed through the retrospective chart review on the Clinical Information System (CIS); (2) the accuracy of alarm limit-setting practices through spot audit.
Major interventions included:
● Development of an evidence-based oxygen titration protocol
● Nurse education session
● CIS enhancement (checking of alarm limit setting every shift)
● Display of cue cards
● Engagement of champion leaders
Data analysis was conducted using hourly SpO2 data from the CIS.
Result & Outcome :
From April 2024 to August 2024, 68 nurses attended education sessions and 62 neonates, with gestational ages ranging from 24 to 41 weeks, were recruited. We analyzed 4,626 hours of SpO2 data. The percentage of time spent within the target oxygen saturation range increased significantly by 20% (p < 0.001, chi-square test). Additionally, the time spent in the hyperoxia range decreased from 44.5% to 21.3% (p < 0.001, chi-square test). This quality improvement project also achieved an 88% accuracy rate in the alarm limit-setting practices.
The program has successfully increased the time of neonates spent within the target oxygen saturation range while concurrently reducing the incidence of hyperoxia. By establishing clear protocols and enhancing monitoring practices, the program ensures safer and more effective oxygen delivery tailored to the unique needs of this vulnerable population.
