1. Inter-Professional Team Improving NICU Outcomes
through the Development and Implementation of EMR-Embedded, Evidence-Based Practice Protocols
S. McGuire, MS, APRN, NP-BC, D. Hill, BS, RN-NIC, C. Whetten, BS, RN-NIC, D. Krieger, MS, APRN, T. Sacco, RN, BS, CPHQ,
S. Capps, MSN, APRN, NP-BC, P. Esposito, MS, RD, A. Spizzoucco, RD, L. Tucker, MSN, APRN, NP-BC, L. Wolkoff, MD, S. Lainwala, MD,PHD
Connecticut Children’s Medical Center, Hartford, Connecticut, United States
BACKGROUND
NICU feeding protocols reduce neonatal morbidity and mortality
Implementation of feeding protocol associated with improved incidence of feeding intolerance, necrotizing enterocolitis and extra-uterine growth restriction
Suboptimal compliance with feeding guideline seen in level IV NICU
PURPOSE
To improve compliance with feeding protocol
To improve assessment of compliance and neonatal outcomes
Gut Priming
Substrate
Feeds
Birth
Weight (g)
Initiation Time
GP Period
Advancement
Feeding Frequency
Within 1st 24 HOL
10 ml/k/d
Q3h
4 days
DBM/MOM/PTF
20 ml/k/d Q24 Q3
10 ml/k/d Q3h
3 days
2 days
20 ml/k/d Q3h
1 days
20-40 ml/k/d Q24
>2000
MOM/PTF/TF
Q3-Q4
Do not change the size or shape of the poster slide. We will be doubling the size of the slide for printing. The posters are wide enough that possibly four columns could be used but are not suggested. Four columns might be useful if you plan to use a row of tables or graphs or pictures.
Keep the Header Fonts and sizes as found on the template this will increase the visibility of the poster topics from across the room and make them easier to read.
Header fonts and size should also remain the same. The header titles for each section are only suggestions but are the ones most often found on a poster.
Font sizes within each section can be adjusted (do not use less than a 16 font size to keep the text readable from afar. Please do not change font styles – again the consistency will make our poster appear more professional when seen as a group.
Bulleted points are best on a poster – lots of text can be difficult to read. Please do not use full sentences and/or paragraphs within each section
Please know that empty space is often a good thing and is visually appealing.
Remember that the poster will be doubled in size so view pictures at 200% to make sure the quality will be good on the completed poster.
For questions or concerns please contact Jackie McGrath --
COMPLETED Posters should be sent to Jackie for approval for printing!!
STRATEGY
EMR order set built to include timed, automatic feeding volume advancement
EMR progress note template built to include smart lists of nutrition related data for future analysis of compliance
INTER-PROFESSIONAL HEALTHCARE TEAM
Staff of a 32 bed, level IV NICU provides a diverse expert skill set to develop an inter-professional team
NICU Nutrition Care and Research Group (NCRG) charged with literature review, protocol development and implementation of unit-based protocol to establish enteral feedings in neonates
Collaboration with hospital-based EMR application analysts to design feeding advancement order set (FAO) and documentation template
FUTURE IMPLICATIONS
Optimize usability of FAO set
Data collection and outcomes reporting from EMR
New applications of EMR based order sets for other quality improvement projects
2009
2012
2013
2014
NICU NCRG formed
Compliance data and literature reviewed
New feeding protocol developed
NCRG/EMR Analysts subgroup formed
Integrate feeding protocol into EMR through FAO sets
Build data collection tools through smart lists in daily progress note templates
Compile data on feeding protocol compliance and neonatal outcomes
Initial evidence-based feeding guideline implemented
Compliance assessment of feeding guideline completed
Implementation of revised feeding protocol
Inpatient EMR implementation