Start Small: The Premie Project

An Interdisciplinary Project to Improve Neurodevelopmental Outcomes in the ELBW.

  • Robin Bisgaard RN, MSN
  • Tanya Kamka RN, MSN
  • Samantha Wynn BSN
  • Kathryn Morrison BSN
  • Amber Mason BSN
  • Ana Estrada Yost BSN
  • Sara Paredes BSN
  • Melissa Liebowitz MD
  • Elizabeth Rogers MD

The Preemie Project is a quality improvement project to improve neurodevelopmental outcomes in our smallest patients (less than 28 weeks gestation or less than 1500 grams). Interdisciplinary teams set out to examine the current evidence and implement a bundle of practice changes.

Interdisciplinary teams included nurses, physicians, nurse practitioners, respiratory therapists, physical therapists, occupational therapists. Teams were formed based on areas of professional interest and expertise. The initial resuscitation, the first 72 hours, respiratory management, blood pressure management, nutrition and developmental care were the primary groups. An additional group of neurodevelopmental team members consulted in a broader purpose for the overall project. An additional group examined periviability counseling and communication between OB services and the Intensive Care Nursery. Teams reviewed current literature and proposed relevant practice changes; these changes were implemented as a “Premie Project” bundle and included education for each discipline. Nursing education coincided with Annual Review, almost 100% of nursing staff received the education course. Additionally, interdisciplinary teams traveled to other departments, including radiology and echocardiography for education presentations.

Project successes have shown significant improvement in the incidence of Intraventricular hemorrhage (IVH) in our patients less than 28 weeks, from 12.8% in the year prior to 10.0% in first six months of the protocol. Change in practice is often met with some resistance. The interdisciplinary approach and engagement has helped the team work together in formulating and following guidelines One challenge we have noted is in the initial resuscitation; as new staff are trained, ongoing mentoring and education is needed.  The initial project focused primarily on a chronological timeline from antenatal through the first 2 weeks. Next steps will focus on best practices based on current evidence for the less than 28 week infant after the first 2 weeks of life.

“The project holds us accountable across disciplines”  Respiratory Therapist

“My care practices can make a big difference in our smallest patients”  Nurse

“This project is great, we are all on the same page”  Nurse

“Purple power…I love knowing that my daughter’s team is doing everything they can to help her outcome”  Mother