Quality Improvement

Overview

The Department of Neonatal MedicineRPA Newborn Care has well developed Quality Improvement initiatives in place. Data on all babies admitted is entered prospectively into the electronic medical record (EMR), and this is utilised each month to identify instances of morbidity and mortality. Cases are discussed at both neonatal and combined obstetric/neonatal meetings . Unit performance is compared periodically against other units, through collaboration in three data collection networks (see below). An emphasis is placed on using the best available evidence to support nursery procedures and protocols. Both Medline and the Cochrane Pregnancy and Childbirth database are available online throughout the departmental computer network.

Data Collection in RPA Newborn Care

Details of the management of babies receiving neonatal intensive care are continuously recorded in RPA's hospital-wide EMR (Powerchart, Cerner Corporation). The EMR generates comprehensive discharge summaries for all babies managed in Newborn Care.

A separate program is utilised to automatically generate drug dose orders, so that staff do not need to perform complicated calculations when working under stress, with proven reduction in prescribing errors.

NSW Neonatal Intensive Care Unit Study (NICUS)

Along with other NSW neonatal units, RPA pools data on designated babies (<32 weeks, or >31 weeks and ventilated) into a statewide neonatal database. This is funded by NSW Health, and coordinated by the NSW Pregnancy and Newborn erinatal Services Network (PSN).

SPRING (Sepsis Prevention in NICUS group)

Since Jan 2012 all neonatal intensive care units within NSW have developed a consensus on definitions for reporting newborn infection and the SPRING group was developed to focus on improving data collection on infection to facilitate benchmarking within NSW and to stimulate quality improvement activities. All infections are now coded at a monthly sepsis meeting by the Neonatologists and the RPA Microbiologist and deidentified feedback for all NSW NICUs units is received monthly in electronic formatally.

Australian & New Zealand Neonatal Network

Along with all Australian & New Zealand NICU's, RPA contributes data on babies <32 weeks or <1500 gm and other level 3/4 babies to the network. (ANZNN) Each unit is confidentially supplied with their own results as well as those for all units combined. This allows units to assess their performance in different areas of care.

Evidence based Medicine - Cochrane Collaboration

The Cochrane Collaboration (CC) grew from the Oxford Database of Perinatal Trials (ODPT), which pioneered the process of basing clinical practice on evidence obtained from randomised controlled trials. By applying meta-analysis to available RCT's on a given topic, many important questions in the area of perinatal medicine have been answered, the classic example being the use of antenatal steroids to improve the outcome of premature babies. Several staff in this department are active Cochrane reviewers

In order to encourage an ethos of EBMevidence based practice, computer access to Cochrane Library, CIAP and Medline is available throughout the Department.

The following in-house quality improvement activities occur within RPA Newborn Care:

Mortality and Morbidity

All perinatal deaths are reviewed and classified monthly by a multidisciplinary group including obstetrics, midwifery, neonatology and an audit officer. Cases are then discussed within combined obstetric and neonatal meetings. In addition a Newborn Care M and M meeting is held every 3 months to discuss all neonatal deaths and prespecified neonatal morbidities in detail with a particular focus on avoidable or preventable factors.

Quality Improvement

A general unit QI meeting is held monthly with a focus on local best practice, NICU environment and equipment. Events reported through the hospital Incident Monitoring Systems (IIMS) are summarised and presented and practice improvement measures are implemented if required.

RPA Newborn Care Infection Prevention Group

This multidisciplinary subgroup of the unit QI committee commenced in 2013 and was established to focus on infection prevention and control within RPA Newborn Care. Initiatives include developing and updating relevant policies/guidelines, performing local audits and research, and providing education.