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841 Routine supplementation of probiotics for prevention of necrotizing enterocolitis in premature infants—a qi project
  1. Asaph Rolnitsky1,
  2. Eugene Ng1,
  3. Yasmin Shama2,
  4. Maren Garche1,
  5. Michael Dunn1
  1. 1Sunnybrook Health Sciences Centre, Canada
  2. 2SickKids, Canada

Abstract

Background Necrotizing enterocolitis (NEC) carries high rates of mortality and morbidity in perterm infants. Our NEC rates over 6 years, were in higher quartiles of the Vermont-Oxford Network and prompted an improvement project.

Objectives To reduce NEC rates by 30% from 4.5% to 3% by 3/2016 in <33 weeks infants admitted in Sunnybrook NICU.

Methods Multi-professional team used fishbone analyses, process maps, literature review and compliance with hospital Infection Prevention unit. A product was selected (BioGaia, Lactobacillus reuteri; Ferring, Sweden). A policy written and approved. As a forcing mechanism, order for probiotics added to admission orders set. We gave education to staff, parents. We started after a cluster of cases (‘burning platform’). PDSA#1 on the first baby was in 2/2015. After first month, issues were addressed, then spot audits assured continuing compliance. Measures: Outcome measures: NEC in infants<33 wk GA, (>=stage 2), Sepsis, Mortality. Secondary outcomes: Sepsis evaluations, Feeding intolerance, Days NPO, Growth rate/week, Antibiotics days, TPN days, Formula days. Process measures: Compliance rate, Probiotics days. Balancing measures: Sepsis, Feeding intolerance

Results One year before (planning periods, 330 infants), and two years into implementation (745 infants). NEC rates declined from 4.3% to a current rate of 1.3%. P-chart of NEC show a sustained reduction, P-chart of compliance shows a sustained compliance. Other outcomes detailed in Table 1. No significant baseline differences.

Conclusions Our QI project used QI tools – teamwork, RCA, aim statement, drivers, standardisation, forcing mechanisms, education, PDSA, and SPC. All supported a feasible, effective, safe, and sustained improvement. Findings are consistent with previous RCTs.

Abstract 841 Figure 1

p Chart:% infants<33 wks given biogaia

Abstract 841 Figure 2

p Chart: NEC rates, infants<33 wks GA

Abstract 841 Table 1

Baseline charactreristics and outcomes

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