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Power NM, Crous EC, North N. Participatory Methods to Improve and Develop Pediatric Nursing Practice: A Scoping Review. Compr Child Adolesc Nurs 2023; 46:41-64. [PMID: 36630534 DOI: 10.1080/24694193.2022.2153945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Children's nurses in African pediatric settings are often responsible for leading practice improvements. There is a shortage of contextually relevant guidance to inform the design of practice improvement projects in African care settings. Distinctive features of children's nursing practice in Africa include high levels of family caregiver involvement, and organizational and professional cultures which value participation. While established practice improvement methods offer many strengths, methods developed in other geographies should not be adopted uncritically. Our purpose in undertaking this review was to inform selection of methods for a multi-center practice improvement project in Africa. Our aim was to identify types of participatory methods used to improve and develop pediatric nursing practice. We used the PRISMA-ScR method to conduct a scoping review to identify published reports of participatory methods used to improve and develop pediatric nursing practice. We undertook structured searches of five bibliographic databases to identify articles. Only articles written in the English language were included and no limitation was applied to publication date. We identified 7,406 titles and abstracts. After screening, 76 articles met the inclusion criteria. A wide range of participatory methodologies were identified; just under half (n = 34) reported on methods that were not recognized or named methodologies but can be described as collaborative in nature. Plan-do-study-act cycles were reported in 22 articles. There was considerable heterogeneity in frameworks, practical tools and/or nursing models on which the participatory methods were based and there was no apparent relationship between these and the choice of participatory methods. The outcomes identified were also heterogenous in nature and were grouped according to whether they improved structure and/or processes and patient outcomes. Most of the included articles stem from high-income countries with little evidence from low-middle-income countries and none in African settings. Less than half of the included articles involved family caregivers in their practice improvement methodologies. This review highlights the need for greater application of formalized methods for practice improvement and improved rigor and consistency in reporting outcomes. There is also a need to formalize participatory practice improvement methodologies specifically suited to Africa's context of children's nursing.
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Affiliation(s)
- Nina M Power
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Elijeshca C Crous
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Natasha North
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Daigneault J, Horgan M, White H, Lee A, Rhein L. Low flow nasal cannula requirement among preterm infants: predictors and description of clinical course. J Perinatol 2022; 42:1680-1685. [PMID: 36045221 DOI: 10.1038/s41372-022-01498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We aim to identify potential risk factors associated with longer duration of supplemental oxygen use in preterm infants at risk for bronchopulmonary dysplasia (BPD) to better inform families and weaning protocols. STUDY DESIGN This is a retrospective study of infants with a birth gestational age (GA) < 32 0/7 weeks admitted to the neonatal intensive care unit (NICU) between October 2017 and September 2019. RESULTS A total of 172 infants met criteria for inclusion and analysis, of which 69 (40.1%) infants required LFNC. Risk factors for longer duration included lower birth GA or birth weight, increased ventilator days, and diagnosis of a patent ductus arteriosus (PDA). BPD was diagnosed in 69.6% who required LFNC, of which 47.8% were discharged on home oxygen. CONCLUSION Younger birth GA, lower birth weight, increased ventilator days, and presence of a PDA were identified as risk factors for longer LFNC duration.
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Affiliation(s)
- Jaclyn Daigneault
- Division of Neonatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Megan Horgan
- Division of Neonatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Heather White
- Division of Neonatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Austin Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Massachusetts General Hospital, Department of Surgery, Boston, MA, USA
| | - Lawrence Rhein
- Division of Neonatology, University of Massachusetts Medical School, Worcester, MA, USA. .,Division of Pediatric Pulmonology, University of Massachusetts Medical School, Worcester, MA, USA.
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Morris L, Cook N, Ramsey A, Alacapa JV, Smith LE, Gray C, Craft JA, Chin R, Christensen M. Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature. J Pediatr Nurs 2020; 50:37-45. [PMID: 31704558 DOI: 10.1016/j.pedn.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 01/09/2023]
Abstract
PROBLEM The paucity of up-to-date recommendations and evidence-based models, whether it is physician-initiated or initiated by other healthcare professionals, for humidified high flow oxygen therapy among children. ELIGIBILITY CRITERIA The inclusion criteria included the following: 1) use of high flow oxygen therapy (≥15 L/min); 2) published studies from the year 2000 and onwards; 3) research article in a peer-reviewed journal; 4) studies conducted in a hospital setting involving paediatric patients <18 years old; 5) availability of full article online. SAMPLE From March to April 2018, electronic databases such as PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica Database, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, SCOPUS, Ovid, Informit, and Google Scholar were accessed. The systematic search initially yielded 41 studies. RESULTS Eventually, three eligible studies were reviewed and appraised. Overarching themes were identified: 1) the lack of weaning standards; 2) the limited focus on young population in intensive care settings; and 3) the paucity of weaning models. CONCLUSION The lack of studies suggested that this is a fertile area for research. In this light, this paper challenged researchers, clinicians, and experts to develop evidence-based standards and models of weaning towards efficient and better quality of care. IMPLICATION This review may lead to the development of nurse-led or nurse-initiated weaning protocols to enable timely weaning intervention for children and thus reduce the need for prolonged oxygen use. Furthermore, this may also instigate an economic evaluation of a nurse-lead weaning against current models of medically lead weaning.
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Affiliation(s)
- Louise Morris
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Nicole Cook
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Amanda Ramsey
- Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Jason V Alacapa
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of New South Wales, Kensington, New South Wales, Australia.
| | - Louise E Smith
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of New South Wales, Kensington, New South Wales, Australia
| | | | - Judy A Craft
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Raymond Chin
- Campbelltown Hospital, Campbelltown, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia
| | - Martin Christensen
- Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Liverpool, New South Wales, Australia; University of Sunshine Coast, Sippy Downs, Queensland, Australia
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Travers CP, Carlo WA. New Methods for Noninvasive Oxygen Administration. Clin Perinatol 2019; 46:449-458. [PMID: 31345540 DOI: 10.1016/j.clp.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Oxygen therapy is an essential part of neonatal care. Targeting oxygen saturations and preventing hypoxemia and hyperoxemia is difficult, particularly in preterm infants. The mode of oxygen delivery directly affects the stability of oxygen saturations, hypoxemia, and hyperoxemia. This stability has important clinical implications. New methods of noninvasive oxygen administration, including closed-loop automated control and servo-controlled oxygen environments, have been developed to improve oxygen saturation targeting and decrease episodes of hyperoxemia and hypoxemia.
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Affiliation(s)
- Colm P Travers
- Division of Neonatology, The University of Alabama at Birmingham, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL 35249, USA
| | - Waldemar A Carlo
- Division of Neonatology, The University of Alabama at Birmingham, Suite 9380 WIC, 1700 6th Avenue South, Birmingham, AL 35249, USA.
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Travers CP, Carlo WA, Nakhmani A, Bhatia S, Gentle SJ, Amperayani VA, Indic P, Aban I, Ambalavanan N. Environmental or Nasal Cannula Supplemental Oxygen for Preterm Infants: A Randomized Cross-Over Trial. J Pediatr 2018; 200:98-103. [PMID: 29705116 PMCID: PMC6109600 DOI: 10.1016/j.jpeds.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To test the hypothesis that environmental compared with nasal cannula oxygen decreases episodes of intermittent hypoxemia (oxygen saturations <85% for ≥10 seconds) in preterm infants on supplemental oxygen by providing a more stable hypopharyngeal oxygen concentration. STUDY DESIGN This was a single center randomized crossover trial with a 1:1 parallel allocation to order of testing. Preterm infants on supplemental oxygen via oxygen environment maintained by a servo-controlled system or nasal cannula with flow rates ≤1.0 L per kg per minute were crossed over every 24 hours for 96 hours. Data were collected electronically to capture real time numeric and waveform data from patient monitors. RESULTS Twenty-five infants with gestational age of 27 ± 2 weeks (mean ± SD) and a birth weight of 933 ± 328 g were studied at postnatal day 36 ± 26. The number of episodes of intermittent hypoxemia per 24 hours was 117 ± 77 (median, 98; range, 4-335) with oxygen environment vs 130 ± 63 (median, 136; range, 16-252) with nasal cannula (P = .002). Infants on oxygen environment compared with nasal cannula also had decreased episodes of severe intermittent hypoxemia (P = .005). Infants on oxygen environment compared with nasal cannula had a lower proportion of time with oxygen saturations <85% (.05 ± .03 vs .06 ± .03, P < .001), and a lower coefficient of variation of oxygen saturation (P = .02). CONCLUSIONS In preterm infants receiving supplemental oxygen, servo-controlled oxygen environment decreases hypoxemia compared with nasal cannula. TRIAL REGISTRATION ClinicalTrials.gov: NCT02794662.
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Affiliation(s)
- Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Arie Nakhmani
- Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL
| | - Shweta Bhatia
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Samuel J. Gentle
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | | | - Premananda Indic
- Department of Electrical Engineering, University of Texas at Tyler, Tyler, TX
| | - Inmaculada Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Namasivayam Ambalavanan
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL,Corresponding author: Colm P. Travers MD, University of Alabama at Birmingham, Pediatrics, 1700 6th Avenue South, Birmingham, AL 35249, United States, 2059344680, Mobile: 2053545008, FAX: 2059343100, ;
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Abstract
The quality of health care is now recognized to vary widely in all medical specialties, including perinatal medicine. A national focus on quality improvement (QI) and patient safety is prompting providers to change and improve the care given to patients. All QI and safety efforts require the use of an improvement model to manage the complex process of improving care. This article reviews the most common frameworks in use today, including the Model for Improvement, Six Sigma, and Lean. Specific tools such as affinity, key driver and fishbone diagrams, process maps and statistical process control, as well as checklists are reviewed, with examples from the perinatal literature to illustrate their use in perinatal QI efforts.
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Affiliation(s)
- Amy T Nathan
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC #7009, Cincinnati, OH 45229.
| | - Heather C Kaplan
- Department of Pediatrics, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC #7009, Cincinnati, OH 45229; Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Kidszun A, Plate M, Arnold C, Winter J, Gerhold-Ay A, Mildenberger E. Standardized weaning of infants <32 weeks of gestation from continuous positive airway pressure – a feasibility study. J Matern Fetal Neonatal Med 2016; 29:3198-201. [DOI: 10.3109/14767058.2015.1118455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- André Kidszun
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, and
| | - Maren Plate
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, and
| | - Christine Arnold
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, and
| | - Julia Winter
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, and
| | - Aslihan Gerhold-Ay
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eva Mildenberger
- Department of Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, and
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Sadeghnia A, Badiei Z, Talakesh H. A comparison of two interventions for HHHFNC in preterm infants weighing 1,000 to 1,500 g in the recovery period of newborn RDS. Adv Biomed Res 2014; 3:172. [PMID: 25250286 PMCID: PMC4166058 DOI: 10.4103/2277-9175.139188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nasal cannula, beside administering low-flow therapy, showed the capability for the administration of continuous positive airway pressure (CPAP) through high-flow nasal cannula (HFNC). Meeting specific physical criteria of 100% relative humidity (RH) and temperature of 37(°)C are the basic interventional requirements to administer oxygen for the newborns through a nasal cannula. Recently, two systems, MR850 and PMH7000, received the Food and Drug Administration (FDA) approval to administer heated, humidified HFNC (HHHFNC). These systems are evaluated in this study based on their humidifying and heating capabilities. MATERIALS AND METHODS This study was done as an RCT on newborns weighing 1,000 to 1,500 g recovering from respiratory distress syndrome (RDS) while nCPAP was administered at CDP = 4 cmH2O, Fio2 <30%. Patients were randomized to two groups of 35 receiving HHHFNC after treatment with nCPAP, with one group using MR850 humidifier and the other PMH7000. The patients were compared according to the duration of HHHFNC administration, repeated need for nCPAP respiratory support, the need for invasive ventilation, apnea, chronic lung disease (CLD), nasal trauma, RH, and temperature of the gases. RESULTS The average time of support with HHHNFC did not show any significant difference in the two groups. There was no significant difference between the groups in the need for nCPAP, invasive ventilation, apnea, nasal trauma, and CLD. The difference in the levels of average temperature and humidity was significant (P value <0.001). CONCLUSION Although the records of temperature and RH in the PMH7000 system was lower than the records from the MR850 system, no clinical priority was observed for respiratory support with HHHNFC in the two systems.
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Affiliation(s)
- Alireza Sadeghnia
- Department of Pediatrics, Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohre Badiei
- Department of Pediatrics, Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hassan Talakesh
- Department of Pediatrics, Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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O'Donnell SM, Curry SJ, Buggy NA, Moynihan MM, Sebkova S, Janota J, Miletin J. The NOFLO trial: low-flow nasal prongs therapy in weaning nasal continuous positive airway pressure in preterm infants. J Pediatr 2013; 163:79-83. [PMID: 23312683 DOI: 10.1016/j.jpeds.2012.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 11/12/2012] [Accepted: 12/04/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if low-flow nasal prongs therapy with room air, compared with no treatment, facilitates weaning from nasal continuous positive airway pressure (NCPAP) in very low birth weight (VLBW, birth weight <1500 g) infants. STUDY DESIGN VLBW infants who received respiratory support for ≥ 48 hours and who were stable on NCPAP for 24 hours were eligible for inclusion in this multicenter, randomized controlled trial. On stopping NCPAP, infants were randomized to receive 1 L/min air via nasal prongs or to spontaneous breathing in room air. The primary outcome measure was failure to wean. Secondary outcome measures included length of time to failure and change in heart rate, respiratory rate, oxygen saturation, and respiratory distress score. RESULTS Seventy-eight infants were randomized: 39 to nasal prongs and 39 to spontaneous breathing. The groups were similar at birth and at randomization. Sixteen infants (41%) in the nasal prongs group failed the weaning process compared with 12 infants (31%) in the spontaneous breathing group (OR 1.57, 95% CI 0.56 to 4.43, P = .48). There were no significant differences between the groups in secondary outcomes. CONCLUSIONS In this study, we did not demonstrate a benefit of low-flow room air via nasal prongs to wean VLBW infants from NCPAP.
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Marcellus L, Harrison A. Quality improvement for neonatal nurses, part I: a framework for advancing the quality and safety of care. Neonatal Netw 2012; 31:81-8. [PMID: 22397792 DOI: 10.1891/0730-0832.31.2.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Quality improvement (QI) and patient safety are becoming increasingly powerful drivers for health care planning and delivery. In this two-part series, the concept of QI will be introduced and implications for neonatal nursing care will be discussed. Part I reviews trends in the fields of QI and patient safety and introduces how neonatal practitioners are currently taking up QI and patient safety in their practice. Part II, to come, is titled "Using a Plan-Do-Study-Act Process to Introduce a Step-wise Framework for Establishing Oral Feeds in Premature Infants" will present the QI process "in action" by describing a QI project conducted in a Level III NICU on introducing and testing a new process for improving the transition from tube to oral feeding for preterm infants.
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Affiliation(s)
- Lenora Marcellus
- School of Nursing at the University of Victoria, Victoria, BC, Canada.
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Ford SP, Leick-Rude MK, Meinert KA, Anderson B, Sheehan MB, Haney BM, Leeks SR, Simon SD, Jackson JK. Overcoming barriers to oxygen saturation targeting. Pediatrics 2006; 118 Suppl 2:S177-86. [PMID: 17079621 DOI: 10.1542/peds.2006-0913p] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Susannah P Ford
- Section of Neonatology, Department of Pediatrics, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108, USA
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