1. QI Pilot Project: Lengths in NICU Susan Carlson MMSc, RD, CSP, LD; Angela Haverly RD, LD, Kirsten Hanrahan, ARNP, PNP, DNP; Angie Rausch, ARNP, PNP

2. Background Measurements of growth are a good indication of overall well being and outcomes in infants. Length is a non-invasive measure of skeletal growth. Accurate measures of length are important for monitoring growth in infants transitioning to home, for high risk and primary care provider follow up, and infant nutrition programs (e.g. WIC). Therefore, measurement of length in stable pre-term and chronic infants should be as accurate and reliable as possible.

3. Quality Issue Problem: Measurement of infant lengths using paper tape measures is inaccurate and unreliable. Purpose: To increase the accuracy, reliability and precision of length measurements in infants in newborn and intensive care units cared for and discharged from UICH. Striving for excellence

4. What’s wrong with this picture? This is Africa! Length board Picture provided by Teresa Davidson, ARNP

5. Pilot Project Methods: Evidence supports the use of length boards, standardized procedures, and staff training to increase the accuracy, reliability and precision of length measurements in infants. Personnel: Lengths to be obtained by NPs and Dieticians. Nursing staff, residents and parents may assist. CRC nurses have agreed to do initial training and competency testing. Change will require teamwork and coordination of measurements with other cares. Cost: Length Board $200 - $300 each Will use existing carts Expanding pilot to other areas (Bay 4, newborn, NIC 2/3) would require additional boards- pilot project to support the need and feasibility for attaining grants

6. Change Forces Stakeholders Infants and families NICU multidisciplinary care team Primary Care Providers High Risk Infant Follow Up WIC Barriers Safety Infection control Storage space Time/coordination

7. Goals- Excellence Increased NP knowledge, confidence, and evidence based techniques for obtaining lengths. Increased documentation of discharge lengths in EPIC growth chart. Increased number of lengths in children at risk for growth failure. Increased reliability, precision and accuracy of lengths measures.

8. Measures Frequency Point audit- 1 day Discharge audit- over a month Accuracy/Precision Survey- Knowledge, attitudes and practices Reliability Repeated measures

9. Reliability Design: For each infant a length measurement will be performed four times, twice each by two experienced Nurse Practitioners. Procedure: 1. NP1- Using tape measure in the envelope, obtain a length using standard procedure. 2. NP1- Reposition the child and obtain a second measure of the child’s length using an unmarked tape. 3. Give the envelope to another nurse practitioner to obtain repeated length within 24 hours. 4. NP 2- Using tape measure, obtain a length using standard procedure. 5. NP 2 - Reposition the child and obtain a second measure of the child’s length using an unmarked tape.

10. Expected Benefits Accurate, precise and reliable lengths measurements to assess growth and nutritional status, detect growth and stature related disorders and provide optimal nutrition support.

11. Next steps Order board Stats consult Education Training Pilot standard of care Post-measures Apply for CMN grant to obtain more boards and roll out to NIC 1-4 and newborn (due March 22!)

12. Questions? Contact: kirsten-hanrahan@uiowa.edu