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  • Quality Improvement Article
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A quality improvement initiative to reduce acid-suppressing medication exposure in the NICU

Journal of Perinatology volume 42, pages 1118–1125 (2022)Cite this article

Subjects

Abstract

Background

Acid-suppressing medications (ASMs) are commonly prescribed in the neonatal intensive care unit (NICU), in particular among preterm infants, despite well-established adverse effects and little evidence to support efficacy.

Local problem

We sought to develop an initiative to reduce ASM exposure in our predominantly inborn level III NICU. Our specific aim was to reduce the number of nonindicated ASM prescriptions by 50% within a 12-month period.

Methods

Our multidisciplinary team developed an evidence-based guideline defining indications for ASM prescription in a level III NICU. Plan-do-study-act cycles included staff education, formal clinical practice guideline implementation, and implementation of standardized documentation tools in the electronic health record (EHR). Outcome measures were the number of nonindicated and total inpatient prescriptions started per month, duration of ASM prescription, and number of prescriptions continued after NICU discharge. Balancing measures were the number of patients started on thickened feeds and number of patients discharged home on nasogastric tube feeds. We used statistical process control and Pareto charts to assess these measures over a 12-month baseline period, 9-month implementation period, and 19-month post-implementation period spanning September 2017–December 2020.

Results

Nonindicated ASM prescriptions decreased from median 3 to 0 per month from the baseline to post-implementation period. Simultaneously, the median number of ASM prescriptions at discharge declined from 2 to 0 per month. The median duration of inpatient prescriptions declined from 23 to 7 days. Rates of patients started on thickened feeds and patients discharged home on nasogastric tube feeds remained stable throughout the study.

Conclusion

Enactment of an evidence-based guideline was associated with a substantial decline in nonindicated ASM use in our NICU and a decline in duration of exposure to ASM’s when prescribed. Our interventions proved effective in altering clinical practice and could be applied to other NICUs with similar patient populations aiming to reduce ASM use.

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Fig. 1: Plan-do-study-act timeline.
Fig. 2: Pareto charts of Documented reasons for Acid-Suppressing Medication Prescription in the Baseline and Post-implementation Periods.
Fig. 3: Control chart of number of nonindicated acid-suppressing medication prescription among NICU hospitalized infants per month.
Fig. 4: Control chart of number of acid-suppressing medication prescription continued at discharge among NICU hospitalized infants per month.

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Funding

No funding was received for this project.

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Authors and Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Julie D. Thai, Sara E. Rostas, Carmina Erdei, Simon M. Manning & Katherine A. Bell

  2. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, USA

    Asimenia Angelidou

  3. Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, USA

    Asimenia Angelidou

Authors
  1. Julie D. Thai
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  2. Sara E. Rostas
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  3. Carmina Erdei
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  4. Simon M. Manning
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  5. Asimenia Angelidou
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  6. Katherine A. Bell
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Contributions

JDT, SER, and KAB contributed to the design and methods for the project. JDT and SER contributed to data retrieval. JDT contributed to the display and statistical analysis of the data. JDT and KAB contributed to the analysis and interpretation of the data, as well as initial drafting of the manuscript. All authors contributed to critical revision of the manuscript prior to publication.

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Correspondence to Julie D. Thai.

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Thai, J.D., Rostas, S.E., Erdei, C. et al. A quality improvement initiative to reduce acid-suppressing medication exposure in the NICU. J Perinatol 42, 1118–1125 (2022). https://doi.org/10.1038/s41372-021-01262-9

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