Improving compliance with AAP recommendations: Sedation for non-emergent neonatal intubations

Objective: In 2010, the American Academy of Pediatrics (AAP) published guidance that premedication should be used for all new born intubations except emergent events. We aimed to use a multi disciplinary approach to improve Walter Reed National Military Medical Center Neonatal Intensive Care Unit (WRNMMC NICU) compliance for nonemergent intubations to greater than 80% by May 1, 2014. Study Design: A quality improvement project was conducted and reviewed retrospectively under IRB approval. Pre-intervention records were reviewed for a 12-month period for all infants admitted to WRNMMC NICU who underwent intubation. Post multi disciplinary intervention, records were reviewed over an 11-month period. Result: Pre-intervention, 65 non-emergent intubations were performed in the WRNNMC NICU, 55% (36/65) received some form of sedation. Overall compliance with guideline-recommended medications was 58%. Post-intervention, 83% (60/72) of non-emergent intubations were performed with sedation. Medication compliance improved to 88% (53/60). Conclusion: Our multi disciplinary approach enabled marked improvement in compliance with AAP guidelines