G404(P) Improving the stabilisation of premature babies at delivery – encouraging routine use of non-invasive respiratory support

Background/Aims Evidence is increasing that even extremely premature babies can be managed with non-invasive respiratory support (eg CPAP) at delivery instead of routine intubation based on gestation. This avoids complications from mechanical ventilation and improves long-term respiratory outcomes. Clinical practice in our unit was noted to be variable and we were an outlier for delivery room CPAP in the 2016 VON (Vermont-Oxford Network) report. Our QI project aims to improve the stabilisation of premature infants ( Method Change ideas were incorporated into 3 PDSA Cycles over 6 months: Simulation to practice implementation of the standardised respiratory management pathway. Simulation to test and practice the pathway with the new equipment in–situ. Implementation in practice with respiratory management flowchart memoires on all resucitaires. Qualitative feedback from simulation debriefs alongside retrospective medical note analysis of respiratory management at delivery for all babies born Results The 6 month data did not show a sustained improvement in the use of non-invasive respiratory support. However the numbers were small and we observed better documentation of decision-making, indicating clinicians were becoming more selective about intubation at delivery. However simulations in-situ did identify important equipment challenges resulting in provision of longer tubing to enable CPAP delivery in confined environments. Positively, the balancing measures were unaffected by the changes we implemented. Conclusions A possibility for the lack of change seen in the 6 month data is that the simulation cycles didn’t involve neonatal consultants who tended to lead the more extreme preterm stabilisations. Educational videos may be more successful in this group and will form the basis of our 4th PDSA cycle.