TABLE 1

Change Package for the Optimizing LOS Collaborative QI Project

1. Standardize nutritional best practices on the basis of physiologic maturity rather than gestational age criteria. Essential practice components include the following:
 1.1 Standardize feeding initiation and advancement for optimal growth
 1.2 Standardize the transition to oral feedings on the basis of physiologic maturity, not gestational age or wt (ideally on the basis of feeding readiness score)
2. Create a discharge planning pathway with clearly identified time points for critical assessments focused on the following components:
 2.1 Create and use a visible discharge checklist that allows documentation of discharge milestones
 2.2 Standardize the timing of infant discharge on the basis of infant medical status, infant functioning, and caregiver competence (rather than arbitrarily chosen or PMA)
3. Standardize the approach to apnea, bradycardia, and desaturation events as follows:
 3.1 Standardize the definition of a “CSCE”
 3.2 Establish a standard approach to care (as demonstrated by standard order sets, checklists, and/or protocols) when a CSCE occurs, including the following: establishing a standard for when treatment is necessary, when treatment should be discontinued, the duration of time between the last CSCE and discharge, and when home monitoring (where available) is appropriate
In standardizing practices, teams at each NICU are encouraged to create their own standards; suggestions and recommendations are provided from other sites to help, but a collaborative-wide standard is not established
Primary references for potentially better practices
 1. Nutritional support of the VLBW infant, CPQCC toolkit, rev. 2008
 2. Discharge planning management, VON QI toolkit 2009
  • CSCE, clinically significant cardiopulmonary event.