Published online November 1, 2006
PEDIATRICS Vol. 118 Supplement November 2006, pp. S177-S186 (doi:10.1542/peds.2006-0913P)
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ARTICLE


Overcoming Barriers to Oxygen Saturation Targeting

Susannah P. Ford, MD, Mary Kay Leick-Rude, RN, MSN, Kerri A. Meinert, BHS, RRT, Betsi Anderson, BSN, RN, CPHQ, Michael B. Sheehan, MD, Barbara M. Haney, RNC, MSN, CPNP, Sherri R. Leeks, MSN, CNNP, Stephen D. Simon, PhD and Jodi K. Jackson, MD

Section of Neonatology, Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri

OBJECTIVE. To reduce hyperoxia in very low birth weight infants who receive supplemental oxygen, the Children’s Mercy Hospital neonatal respiratory quality improvement committee introduced the potentially better practice of oxygen saturation targeting and identified strategies to overcome barriers to implementation of this practice.

METHODS. Using rapid-cycle quality improvement projects, this center adapted an oxygen saturation targeting protocol and tracked hourly oxygen saturation as measured by pulse oximetry in very low birth weight infants who received supplemental oxygen.

RESULTS. The percentage of time in the range of 90% to 94% of oxygen saturation as measured by pulse oximetry increased from 20% to an average of 35% after implementation of the protocol. The percentage of time with oxygen saturation as measured by pulse oximetry >98% dropped from 30% to an average of 5% to 10%.

CONCLUSIONS. A well-planned strategy for implementing oxygen saturation targeting can result in a sustained change in clinical practice as well as change in the culture of the NICU regarding the use of oxygen.

Key Words: oxygen saturation targeting • quality improvement • very low birth weight • retinopathy of prematurity • chronic lung disease

Abbreviations: SpO2—oxygen saturation as measured by pulse oximetry • STOP-ROP—Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity • BOOST—Benefits of Oxygen Saturation Targeting • VLBW—very low birth weight • ROP—retinopathy of prematurity • QI—quality improvement • PBP—potentially better practice • FAQ—frequently asked question • FIO2—fraction of inspired oxygen • NNP—neonatal nurse practitioner • PPHN—persistent pulmonary hypertension • RN—registered nurse • RT—respiratory therapist

Accepted Jul 18, 2006.