Developmentally Supportive Positioning in Preterm Newborns: A Quality Improvement Initiative

OBJECTIVES: To increase the proportion of preterm infants achieving acceptable positioning [Infant Positioning Assessment Tool (IPAT) Score ≥8] from baseline 6% to ≥75% within 6-9 mo. METHODS: A quality improvement initiative was conducted in a tertiary teaching hospital's Neonatal Intensive Care Unit (NICU). Preterm infants (<37 wk) cared under radiant warmers/incubators were assessed daily using the validated IPAT Scoring (0-12) across six body domains. IPAT scoring was undertaken across shifts by trained "positioning champions" (senior residents and experienced nurses). Sequential PDSA cycles introduced staff training by Positioning Champions, IPAT cards, thicker nesting, a low-cost "Nest-in-Nest" bedsheet technique, onboard training, and supportive supervision. RESULTS: Of 210 infants [mean (SD) gestational age 32.78 (2.44) wk; mean (SD) birth weight 1.69 (0.55) kg], 1051 IPAT observations were collected. Acceptable positioning improved from 12/201 (6.0%) at baseline [median (IQR) IPAT 4 (2, 5)] to 88/302 (29.1%) after PDSA-1 [median (IQR) 6 (5, 8)], 194/301 (64.5%) after PDSA-2 [median (IQR) 8 (7, 9)], 56/71 (78.9%) after PDSA-3 [median (IQR) 9 (8, 10)], and 156/176 (88.6%) in the sustenance phase [median (IQR) 9 (9, 10)]. CONCLUSIONS: A stepwise, team-led package that pairs hands-on training with simple, locally made positioning support and continuous feedback can improve and sustain acceptable positioning in a resource-constrained NICU.