Minimizing Lung Injury Homeroom Driver Diagram Overarching Aim Primary Drivers / PBPs Secondary Drivers / Change Ideas Disseminate info re nasal CPAP in VLBW infants < 33 wk Promote nasal CPAP for initial stabilization and following extubation Identify and empower RTs to lead promotion of stabilization on nasal CPAP Minimize the duration of ventilation by promoting permissive hypercapnia and early extubation Intubate if not meeting these criteria, follow INSURE method Establish weaning and extubation protocols and audit compliance daily Reduce CLD or death at 36 weeks for actively treated inborn infants with gestational ages of < 32 6/7 weeks and < 1500 grams Establish protocol for caffeine citrate - prior to extubation / weaning Use a gentle ventilation strategy with low tidal volume, high rate, permissive hypercapnia and low pH Develop protocol to wean tidal volumes < 4cc/Kg and high rates > 60 per min Ensure physician, RTs, and nurses are knowledgeable re weaning protocol Administer surfactant if mechanical ventilation is necessary Practice respiratory care protocols & set expectation for daily attempts to wean Administer caffeine when weaning from the ventilator is first attempted Create criteria for intubation/surfactant Consider INSURE approach or rapid weaning if immed. extubation no possible Administer a course of antenatal corticosteroids to women in preterm labor likely to give birth before 34 weeks’ gestation Oral admin. of caffeine citrate when tolerating full enteral feeds Establish guidelines for antenatal steroids in collaboration with OB Family-Centered Care Foundational Principle to be included in every aspect of improvement Teamwork Foundational Principle to be included in every aspect of improvement