In neonatal intensive care units (NICUs) it's not uncommon to poke and prod infants to run labs, but each invasive procedure increases the risk of infection. Intermountain Healthcare's Dixie Medical Center adopted a program to reduce that risk—and saw big improvements in patient safety in and reduced operation costs, Christopher Cheney writes for HealthLeaders Media.
R. Erick Ridout, a neonatologist at Dixie Regional, explained that NICU "babies are routinely put through pokes, and labs are run every Monday, Wednesday, and Friday to demonstrate babies are normal." But he added not every baby requires those procedures. "If we look at a pre-term baby who is thriving, gaining appropriate weight every day, with normal temperature—checking all the boxes—conducting labs on that baby to make sure it is normal does not help. It hurts the baby," Ridout said.
Jeannette Cutner, a nurse manager at Dixie Regional, explained, "We knew that every time we punctured their heels over a 24-hour period there was an increased chance of sepsis. We knew that if we kept lines in for longer than seven days, there was an increased chance of central line-associated bloodstream infections (CLABSI)."
So in 2008 the hospital launched a program called POKE—preventing pain and organisms from skin and catheter entry—to reduce unnecessary invasive procedures.
To get the program off the ground, first, the hospital had to frame the conversation appropriately.
Ridout said, "The most important first step was aligning the team under the idea of all care needing to be value-added, and care that was not value-added represented harm."
Another challenge was the lack of literature on the difference between invasive procedures that add value in the NICU and those that don't.
So the hospital assembled a "highly engaged team" to start gathering data. "We first started out rudimentarily on paper, then we programmed a database to record every single decision we made and what it meant on behalf of the patient," Ridout said.
Patient observation was key to the success of POKE, Ridout said, as NICU staff were able to rely on "the reams of data the baby already provides."
Since implementing the POKE program, Dixie Regional has seen positive results. For example:
- Over 11,000 "pokes" have been avoided;
- Operational costs are down by 28%; and
- Length of stay is down by 21%.
Based on those results, POKE has been implemented at other intermountain hospitals as well as in several other health systems, including Loma Linda University Health, University of Alabama at Birmingham, and Florida Hospital, Cheney reports (Cheney, HealthLeaders Media, 4/16).
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