198 - Positioning-Focused Quality Improvement Initiative to Improve Motor Outcomes in Preterm Infants ≤32 6/7 Weeks in a Level IV Neonatal Intensive Care Unit
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 198 Publication Number: 198.439
Giselle Gozum, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Priyanka Tiwari, Weill Cornell Medicine, New Hyde Park, NY, United States; Aida R. Osis, New York Presbyterian Hospital, Woodbridge, NJ, United States; Elana Siegel, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Jeffrey Perlman, Weill Cornell Medicine, New York, NY, United States
Clinical Fellow NewYork-Presbyterian Komansky Children’s Hospital New York, New York, United States
Background: Preterm infants born ≤32 weeks gestational age (GA) are at risk for neurodevelopmental impairments including motor problems such as fine motor and coordination disorders. Studies have shown that basic motor-specific interventions, i.e., supportive positioning (midline, flexed), can be initiated early in the neonatal intensive care unit (NICU), and has been associated with improved motor assessment scores from as early as three to 24 months post-discharge. The Infant Positioning Assessment Tool (IPAT) is a standardized tool used to demonstrate appropriate positioning of body segments. The Test of Infant Motor Performance (TIMP) can be performed in the NICU and has been shown to predict motor outcomes at follow-up. Developmental care practices that include supportive positioning are lacking in our NICU. Objective: To determine whether adherence to a positioning protocol as assessed by IPAT scores will be associated with an improvement in motor outcomes as assessed by TIMP scores at term equivalent age in infants born ≤32 6/7 weeks GA in the NICU. Design/Methods: A multidisciplinary quality improvement (QI) team was established to identify primary drivers that affect positioning and interventions targeting the drivers were created to improve positioning (Figure 1). Process and outcome measures included mean days to referral to physical (PT)/occupational therapy (OT), average IPAT scores tracked weekly, and TIMP z-scores. Balancing measures included pressure injuries and unplanned extubation rates. Statistical process control charts and established Associates in Process Improvement rules for special cause variation were used to display and analyze data. Results: There was a decrease in mean days to referral to PT/OT in the target population from 22 to 5 days (Figure 2). There was an increase in the average IPAT score from 6.2 to 6.8 (target score ≥ 9), with a center line change in the following body segments – hands, hips/pelvis, and knees/ankles/feet (Figure 3). No change was noted in TIMP scores. No adverse events were noted.
Conclusion(s): A multidisciplinary QI approach that included use of positioning guidelines and standardized position equipment significantly and safely improved appropriate positioning in preterm infants. There was improvement in overall IPAT score with an improvement in body segments except head, neck, and shoulders. These promising initial observations have identified areas for further improvement and next PDSA cycles, with targeted interventions for the head and neck region. Long term follow-up is essential to assess the benefits of these interventions on long-term motor outcomes.
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