Oxygen With Love: Reducing the Need for Laser Surgery in Preterm Infants

Presentation Transcript

Team Members

The Outstanding NICU Nursing Staff

Barb Hering, RNC, MSN, & Lisa Festle, RNC, MSN

NICU Education Co-Chairs

Marianne Chybik, APN/CCNS, Neonatal Case Manager

Elaine Trulis RN, BSN, Nurse Manager, NICU

Marc Weiss, MD, Director of Neonatology

Confidential: For Quality Improvement Purposes Only

Oxygen With Love

Blindness occurs in approximately 2% of premature infants born under 1200 grams. Retinopathy of Prematurity (ROP) is a disease of the retina. ROP in VLBW infants (< 1200 grams) tends to be the most severe. It is associated with retinal scarring and detachment which can result in blindness. There is no successful treatment once the retina has been damaged.
Best practice evidence demonstrates that maintaining a targeted saturation range based on gestational age may reduce the incidence and severity of ROP

Aksie LM, Henderson-Smart DJ. Early versus late discontinuation of oxygen in preterm orlow birth weight infants; Cochrane Datatbase Syst Rev: 2001 (4) CD001076.
Chow et al. Can changes in clinical practice decrease the incidence of severe retinopathy in very low birth weight infants? Pediatrics: 2003,111: 339.
Personal communication with Dr. Goldsmith regarding his presentation entitled "Oxygen Targeting". 4th National Neonatal Nurses Meeting, October 3, 2004

Oxygen With Love

Retinopathy Of Prematurity (ROP) is a common complication of prematurity associated with high levels of oxygen administration.
Laser surgery is required in infants with severe ROP
30% of infants with ROP that reached threshold and received surgery had unfavorable vision as long as 10 years later

Oxygen With Love

Higher oxygenation in the early neonatal period increases the risk for ROP, especially in the premature and/or low birth weight infant.
Fluctuation in saturations (hypoxia/hyperoxia).
Difficulty in maintaining SaO2 within tight control at all times – intensive surveillance at bedside is required, with frequent adjustments in percentage of oxygen administered

Oxygen With Love

Decrease the incidence of severe ROP as measured by a decrease in the amount of laser ablation surgery performed in the NICU
Goal or Target:4 % or less (Vermont Oxford Network data national average 3.98%)
Source of Goal or Target: VON data

Oxygen With Love

Laminate additional bedside OWL cards (supply limited/missing cards)
Every Sunday night Charge Nurse will make announcement for RN to ensure OWL card and MD order are present and reflect correct gestational age
Reaudit alarm limits, OWL cards, MD orders: in progress 02/08
Obtain 2007 LUHS laser surgery data
Review staffing guidelines for labile patients with E. Trulis
Plot improvement on bar graph displayed in unit

Oxygen With Love

Oxygen With Love

Since implementation of Seemore the OWL, the laser ablation rate for infants with severe ROP has been cut in half.
Patient benefit:

Oxygen With Love

Continued use of Seemore the OWL cards at each bedside
Intermittent oxygen saturation audits to monitor compliance
Continued monitoring of the laser ablation rate in the NICU
Continued comparison of LUMC NICU outcomes to those within the Vermont Oxford Network