Introduction of Care Bundle for Non-invasive Respiratory Support for Neonates Admitted to a Tertiary Neonatal Unit in the United Kingdom: A Quality Improvement Project

Background: It is widely recognised in neonatal practice that there is variation in the instigation, switching and weaning of infants between various forms of non-invasive ventilation. With continuous positive airway pressure (CPAP) circuits lasting seven days and high flow, high temperature, humidified nasal cannula oxygen (HFNCO2) circuits lasting thirty days there is a clear financial incentive to minimise circuits used.

Objective: Introduction of care bundle to standardise initiation and switching of non-invasive respiratory support in babies needing respiratory support will lead to reduction of respiratory circuits being used for non-invasive support, making its use more efficient.

Methods: Pre-intervention data was analysing using Badger data from all babies born in 2016 looking at the number of CPAP and HFNCO2 circuits utilised. A comprehensive teaching package was introduced to the nursing and medical teams around circuit usage and costs (£93 per CPAP circuit and £101 per HFNCO2 circuit). Specific guidelines were developed to guide initiation, switching and weaning of respiratory support. Post-intervention data was collected from all babies born in 2017 for comparison.

Results: There was decreased use of CPAP and HFNCO2 circuits in babies requiring respiratory support. Regarding CPAP there was a reduction from 1.53 circuits per baby to 1.0 and with HFNCO2 this was 0.64 circuit per baby to 0.49. In lower gestational ages this was more significant; under 28 weeks gestation it went from 2.44 to 1.59 circuits per baby with CPAP and 1.02 to 0.58 circuits per baby with HFNCO2. This equates to a gross yearly saving of £22,800 (assuming a similar patient population with 3000 annual admissions).

Conclusion: Introduction of a care bundle involving an education package, clear written guidelines and increased awareness of durations and costs of CPAP and HFNCO2 circuits amongst medical and nursing staff leads to considerable cost savings when incorporated into clinical practice.