Quality Indicators in Neonatal Medicine Potential collaborative research projects Imad MELKI M.D. NCPNN
Quality Indicators: 1- An agreed-upon process or outcome measure that is used to determine the level of quality achieved. 2- A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or achievement of quality goals.
Quality indicators (QI) are used to assure a better standard of care in each unit or departement. Their use can lean on the following items: 1- Voluntary v/s mandatory participation of the people involved in a departement. 2- Scope: QI could be used on a local scale (hospital), wider scale (network) or a broad scale (a country). 3- Usefulness: QI are useful to different stakeholders at different degrees: Payers, governments, health care organisations and laboratories.
QI in normal Nursery Teaching parents the standard care of a healthy newborn; Pain and sedation; Teaching of medication; Screening: Metabolic or other congenital disorders Hearing
QI in NICU facilities Use of certain techniques: endovascular Kt, endotracheal tubes, ventilation, HFV, NO, etc. Need to evaluating each of these techniques: Kt misplacement; Endotracheal tube misplacement; Nosocomial infections Occurence of bed sours; Etc.
QI in NICU facilities (ctnd) Reporting and evaluating medical errors; Global care of the sick newborn and his parents (and/or environment): medical, social, economic and psychological support; Pain and sedation; Teaching how to give medication to the newborn after discharge; Discharge planning.
Some indicators to be considered Screening for inborn errors of metabolism or other congenital diseases: PKU, hypothyroidism, galactosemia, cystic fibrosis, etc. This program exists in Lebanon since 1996, but is not used in all newborn facilities. Needs to have specific «targeted diseases» adapted to our local needs. Is a essential QI, wich denotes a rational and modern approach to preventing «potentially treatable diseases». Not expensive. Should be entirely supported by public instances!!!
Some indicators to be considered Screening for Hearing deficit Important QI; one of the most common congenital anomalies; Indicator of modern management and good awarness; Leads to an early and efficient management of children with hearing defects (after being confirmed by appropriate investigation); Not expensive.
Some items to be considered Pain and sedation NN: blood sampling; circumcision. NICU: Invasive procedures: Kt insertion, Intubation, LP, Chest tube insertion, etc. Blood sampling
Some items to be considered Teaching of Medication: Do we really take our time (Attendings, Residents, Nurses, Midwifes) to teach correctly very concerned parents on what to administer, in which way, at what time and for what period of time??
Some items to be considered Discharge planning When leaving NN or essentially NICU: Staff meeting: attending, resident, intern, nurse or midwife, and eventually psychologist or a social worker Post discharge surveillance
Conclusion QIs are motors for improvment in the standard of care; QIs should be carefully studied and standardized; QIs should be applicable in all health facilities; QIs are valuable elements for hospital accreditation.
Conclusion Best Examples: A surveillance system who can monitor Incidence of nosocomial infections Cost of stay Birth defects Etc.
Conclusion Achievements could be done by the means of the network: every 2 or 3 centers affiliated to the network could be responsible of studying or assessing one or more QI. By merging and comparing data, we can achieve standardization process. This could be easily done because all data are pooled and easily exploitable.