NICU
Protocols
Welcome To
NICU Protocols
Enhancing healthcare quality and safety at the bedside of every patient by reducing variation in care. Standardizing neonatal care through the provision of evidence-based clinical management algorithms to front-line clinicians.
Introduction
Dear Friends and Colleagues
While each hospital is unique, with its own specific needs and challenges, the evidence we have from numerous outstanding clinical trials and research studies is universal and should guide clinical care everywhere. For instance, if a patient is experiencing a heart attack, they should receive the same level of care whether they are in a hospital in London or San Diego. Likewise, many aspects of neonatal ICU care are supported by robust evidence. These evidence-based treatments should be implemented in every NICU, as it is, in many ways, a patient's right to receive the standard of care.
This standard of care should also be a benchmark for what constitutes high-quality care. Unfortunately, efforts to standardize care are sometimes met with resistance, despite the clear benefits of reducing variability. Standardizing care not only enhances the quality of care and patient outcomes but also improves the safety of healthcare delivery.
This website is intended to serve as a blueprint for establishing a strong culture of quality and safety within your unit. It aims to help optimize workflow, enhance provider satisfaction, and improve patient outcomes by ensuring that evidence-based care is consistently delivered at every bedside.
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​Everyone who works in healthcare is passionate and committed to doing a good job. We strive to provide exceptional, compassionate care to our patients around the clock. As healthcare professionals, we are always on, and within our evolving healthcare system, this means we are continuously monitored and evaluated. However, many healthcare workers feel that our professions are often subjected to a negative and punitive tone. Unfortunately, the infamous ABCs of medicine—Accuse, Blame, and Criticize—still persist in many institutions and units. The increasing demands of documentation, billing, frequent technological changes, rising healthcare costs, and financial pressures frequently impact healthcare providers in their daily work, leading many to consider leaving the profession.
For many, quality improvement and healthcare safety feel imposed, with a perception that they interfere with front-line work. Quality improvement projects often fall into the hands of individuals more interested in micromanaging than in empowering providers by sharing the "why" and fostering a shared, compelling vision for everyone to work towards.
Our goal is to demystify quality improvement work and make it accessible to every clinical provider, integrating it into everyday clinical practice. All aspects of this overview are interconnected and ultimately contribute to incorporating a high level of quality and safety focus into every patient encounter. The text is structured as a blueprint for establishing a robust quality and safety infrastructure in your unit.
Process improvement refers to the infrastructure within the unit aimed at driving quality, including processes, order sets, protocols, communication, team building, setting expectations, and creating a foundation for consistent high performance.
Performance improvement addresses how effectively people utilize the processes established in the unit and identifies needs for developing new processes. Many terms associated with quality improvement, such as the PDSA cycle, Lean, and Kaizen, relate to performance improvement.
High reliability is a state achieved through a developed and shared culture that embraces processes aimed at enhancing quality and safety, while also using performance improvement tools to consistently and continually improve based on collected data.
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Empower Our Profession, Enhance Patient Care, and Reduce Costs—All While Spending More Time Where It Matters Most: At the Bedside.
Understanding Quality Improvement
Quality and safety initiatives in healthcare are often obscured by poorly defined terminology that can seem intimidating, restrictive, or controlling. However, establishing a robust quality infrastructure enhances clinical control, improves care, reduces errors, and grants clinicians greater freedom to engage with patient care at the bedside. Integrating evidence-based medicine into the daily clinical care of patients should be the standard expectation, with individualized patient medical and personal needs addressed alongside this evidence-based foundation.
​While medical management in the NICU is inherently complex, standardizing clinical care based on evidence, though challenging, is achievable. Reducing variability in care not only optimizes and elevates the quality of care but also minimizes the risk of medical errors. Every effort should be made to diminish this variation.
In this regard, the focus is on standardizing the clinical management of specific conditions, such as RDS and hypoglycemia, while also emphasizing preventive strategies aimed at reducing the risk of NEC, BPD, and invasive infections. This approach provides every NICU with a blueprint for developing a strong evidence-based infrastructure, thereby creating a process-oriented architecture.
The principles of quality and safety, along with much of the associated terminology, have been derived from the fields of engineering, production, and the aviation industry. Imagine, for instance, an airport without established processes for check-in, baggage handling, security screening, or boarding. Similarly, consider the chaos if pilots had no pre-flight checklists, no protocols for fueling, and no standardized communication with air traffic control. With nearly 10,000 planes in the air at any given time, carrying over a million passengers, strict adherence to guidelines, checklists, and protocols is what ensures safety and efficiency. The aviation industry operates within a process ecosystem that is mirrored in every flight around the world, highlighting the importance of such systems in achieving consistent and safe outcomes.
What We Do?
We provide evidence-based clinical guidelines in form of protocols, checklists, and processes.
We provide education on how to become a highly reliable and high-performing NICU.
"When you change the plan in the last minute you make it vulnerable."
Cady Coleman, NASA astronaut
Collaborate
Please feel free to contact us if you're interested in collaborating on a quality improvement project, seeking advice, or sharing a completed NICU project or an educational safety event. Kindly remember to avoid including any patient-identifying information. We also welcome any feedback you may have regarding the website. Thank you! We look forward to hearing from you and expanding the neonatal quality improvement space together.