1. 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