Optimizing Nurse-Led Rounds to Reduce Ventilator Days in a Bronchopulmonary Dysplasia Cohort

BACKGROUND: Intensive care unit (ICU) nurses improve patient outcomes through respiratory weaning protocols, yet this is not standard practice in the neonatal ICU (NICU). Infants born extremely prematurely, <28 weeks gestational age, are at risk for the development of severe bronchopulmonary dysplasia (BPD). Reducing exposure to invasive mechanical ventilation (iMV) can reduce the severity of BPD, yet it remains a challenge. PURPOSE: This quality improvement initiative assessed the effect of optimizing nurse-led rounds scripts on the interdisciplinary rounding structure and explored iMV time among infants in a BPD cohort. The 3 objectives were education, script compliance, and iMV time. The project was guided by the Plan-Do-Study-Act cycle model and Lewin's Change Theory. Implementation occurred in a level IV NICU within a single children's hospital. The population included 240 NICU nurses, 57 neonatal nurse practitioners, and 118 neonatologists caring for a cohort of 18 patients with BPD. METHODS: Nurses-led rounds through an optimized respiratory script for a cohort of patients with BPD. After 90 days of implementation, nurses' confidence, autonomy, and respiratory knowledge were compared. iMV time for the patients with BPD was retrospectively reviewed. RESULTS: Daily script usage improved to 61% by day 90. Education was completed by 99% of the nurses. The nurse's confidence, knowledge, and sense of autonomy all increased. IMPLICATIONS FOR PRACTICE AND RESEARCH: These results indicate that nurse-led rounds scripts benefit NICU nurses' leadership, improve interdisciplinary collaboration, and improve respiratory outcomes for NICU patients.