Educational Rounding for BPD Prevention

Background: Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity. Despite advances that have significantly improved extremely low birthweight (ELBW) survival, BPD rates have not made any significant improvement within our institution. While several potentially better practices have been proposed to prevent BPD, none of these have individually shown to affect the prevalence of BPD. Bedside staff engagement, revealed significant knowledge deficits, and workflow barriers to meaningful bedside assessment and effective application of supplemental oxygen. A recurring theme in these interviews led to the conclusion that there was a significant gap in understanding of neonatal physiology. Bedside education was needed on neonatal lung development, physiological drivers of BPD, target SpO2 ranges per gestational age, SpO2 alarm limits, and how to read and use histograms on the monitors. It was then decided to start weekly BPD Prevention rounds. Methods: The weekly BPD prevention rounds were led by a respiratory therapist and registered nurse. The goals for these rounds were to provide education to the bedside staff about neonatal lung development, physiological drivers of BPD, target SpO2 and alarm limits per gestational age, how to read and use histograms, and proper oxygen utilization. By providing this education the hope was to give the bedside provider the tools to help prevent BPD and ultimately, decrease our BPD rates. Results: 87.50% of the team agreed that the BPD prevention rounds have been beneficial. 83.33% agreed that the BPD prevention rounds have taught them how to help prevent BPD as a bedside provider. 91.67% agreed the BPD prevention rounds have taught them to utilize histograms. 83.33% agreed the BPD prevention rounds have helped encourage them to use less oxygen. Conclusions: The weekly BPD prevention rounds have been instrumental in educating all of our bedside providers on BPD prevention and oxygen utilization in our level IV NICU.