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Quality Improvement and Safety in the Neonatal Intensive Care Unit :

May 10, 2017

As I walked into the neonatal intensive care unit (NICU) for the huddle, I was greeted with, “It is good to see you, but why are you here?”

As I walked into the neonatal intensive care unit (NICU) for the huddle, I was greeted with, “It is good to see you, but why are you here?”

As I am no longer clinically active, my “day job” is coordinating quality improvement (QI) projects with the nurses, nurse managers, neonatal nurse practitioners, residents, fellows and attending neonatologists. As anyone whose job also involves QI knows, you face challenges in this role anywhere in the hospital, clinic, and office or on the floor. It has, however, become an important part of monitoring and “quantifying clinical care growth” for patients and their families (1).

In the April issue of NeoReviews, Drs. Hannah Fischer and Dan Stewart contribute a comprehensive, well-organized and educational paper about QI and safety in the NICU (2). This article focuses on an in-depth approach to the organization and installation of a NICU safety program in nonjudgmental fashion for the benefit of the patients.










Our own NICU QI and safety program includes measures in different categories as presented in their article:

Measures of errors:  

1) monitoring of medication errors;

2) breastmilk administration errors.

Measures of adverse events:

3) central-line-associated blood stream infections (CLABSIs);

4) catheter-associated urinary tract infections (CAUTIs); and

5) organizing a multidisciplinary unplanned extubation project (3).

Safety process measures:

6) hand hygiene.  


7) NICU transport response times and reasons for delays.

We are also in the early stage of collaboration with the Illinois Perinatal Quality Collaborative in the Golden Hour project to improve team and family communication and admission temperature in infants ≤30 weeks’ gestation.

The greatest challenges we have found with quality improvement/safety projects are not so much in the set-up and organization but in achieving buy-in by the clinical care providers and sustaining of some of the projects. It is also important to have a true reflective multidisciplinary group involved from the beginning of the process with ongoing monitoring of the collected data. This process is ongoing and involves serial plan-do-study-act cycles with a dedicated group of participants (4).

With time, I am hoping that when I walk into NICU I will be greeted with, “It is good to see you, and we are really glad the QI projects are in place.”


1.     Hageman JR. Uncommon infectious disease presentations and a reminder that quality improvement in meant to improve care. Pediatr Ann. 2017;46:e33.

2.     Fischer HR, Stewart DL. Quality improvement and safety in the neonatal intensive care unit. NeoReviews. 2017;18:e201-e208.

3.     Merkel L, Beers K, Lewis MM et al. Reducing unplanned extubations in the NICU. Pediatrics. 2014;133:e1367-e1372.

4.     Health Literacy Precautions Took-kit. 2nd ed. Plan-do-study-act (PDSA) directions and examples. Available at https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html. Accessed May 1, 2017.


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