(44) An Interdisciplinary Quality Improvement Initiative Results in Individualized Supplementation to Support Bone Health in High-risk Neonates

Priya V. Creed, Indiana University, Indianapolis, IN, United States; Beatrice Stefanescu, Indiana University, United States; Huff Katie, Indiana University, United States

Background: The best approach to metabolic bone disease of prematurity (MBDP), a common morbidity in neonates, is timely screening with the goal of optimizing nutrition early. Unfortunately, there is significant practice variation in MBDP screening practices in neonatal intensive care units (NICU). This was evident through our prior needs assessment data showing that only 13% of the infants were appropriately screened. This compelling data showed a critical need for practice improvement for MBDP screening in our NICUs.

Objectives: To increase screening for MBDP for all infants born < 1500 grams and < 32 gestational weeks with a bundle of serum calcium, phosphorous, and alkaline phosphatase at four to six weeks of life from a baseline of 36% to 90% by June 30, 2022.

Design/Methods: This is a pre-/post-intervention quasi-experimental design study using quality improvement (QI) framework. The baseline period is October 2020 to June 2021. Our study period starts July 2021, and ongoing prospective chart review is being performed to determine our post-intervention screening rate on a monthly basis. We identified stakeholders and formed an interdisciplinary team of neonatal providers, dietitians, and nurse. A key intervention was the creation and dissemination of a standardized, evidence-based screening algorithm for our NICUs (Figure 1). This algorithm along with other interventions were implemented through reiterative Plan-Do-Study-Act cycles.

Results: A total of 97 patients were included in the baseline period and 61 patients so far in the post-intervention period. The proportion of infants who received bundled primary screening was 36% during the baseline period, which improved to 92% after this QI initiative (Figure 2). Of the 56 patients that had primary screening in the post-intervention period, 23 (41%) proceeded with secondary testing (Figure 3). In the end, a total of 13 of the 61 eligible patients (21%) had abnormal primary and secondary screening results prompting a change in their supplementation.

Conclusion: Our interdisciplinary QI approach has not only preliminarily resulted in a significant improvement in our primary screening rate but it has also allowed us to optimize supplementation for patients with MBDP. These increases in supplementation were individualized to each patient’s nutrient deficiencies as evident through abnormal testing results. Our next steps include efforts that will help us improve our secondary screening rate. Additionally, we plan to expand this initiative to other NICUs within our hospital system with the potential of making it a state-wide or nationwide collaborative in the future.