PC1086: A Quality Improvement Effort to Improve Parental Comfort with Home Oyxgen Therapy Is Associated with a Decreased Duration of Home Oxygen Therapy

Purpose/Objectives: Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity and many patients require prolonged home oxygen therapy (HOT). Our team uses a standard protocol for outpatient weaning which relies on increasing time off oxygen before discontinuing therapy. This protocol weans infants in a median of 21 weeks after NICU discharge. This process does not start until the first clinic visit 4-6 weeks after discharge. We questioned if we were missing a key opportunity to shorten the duration of HOT. Our objective was to shorten the duration of HOT by introducing the process of weaning while in the NICU.

Design/Methods: We launched a quality improvement (QI) program in April 2021, guided by a team of representatives from neonatology and pulmonology. Preterm infants born < 32 weeks gestational age with BPD (defined as respiratory support at 36 weeks’ PMA) and without significant comorbidities were eligible once they required £ 0.5L NC at FiO2 1.0, a level of support typically utilized for infants anticipated to discharge on HOT. Infants were trialed off oxygen for a maximum of 30 minutes. If they tolerated 30 minutes without desaturations or increased work of breathing, they became eligible to have oxygen removed for 30 minutes daily. Infants who did not tolerate the initial trial were reassessed weekly until they either tolerated a full 30 minutes or were discharged. Parents were instructed on infant monitoring and the protocol during these trials. Outcome measures included the duration of HOT. Process measures focused on our protocol adherence. Balancing measures included NICU length of stay, incidence of retinopathy of prematurity, and weight gain.

Results: In total, 50 infants with BPD requiring HOT were evaluated in our baseline period (03/2020 through 03/2021) and 18 eligible infants were identified after initiation of the QI project (04/2021-01/2022). Of the 18 infants, 11 (61%) actively participated in the protocol. In our trial period, we tested the existing outpatient protocol in our NICU. In Cycle 1, we improved processes to align with inpatient workflows, including improving education for families and nurses. In Cycle 2, we began issuing weekly reminders to providers to improve adherence to the protocol. Infant characteristics in both periods are similar (Table 1). Duration of HOT is depicted as an XMR chart and reflects current state of the ongoing QI study (Figure 1).

Conclusion/Discussion: Our data demonstrate a reduction in the duration of HOT after the start of Cycle 1. Our analysis suggests that a program to introduce an outpatient protocol prior to discharge can effectively decrease duration of time on HOT. Further work will aim to improve the home discharge process for infants with BPD, including a more structured educational process for families as well as a discharge checklist for HOT.