Less Invasive Surfactant Administration: A Quality Improvement Project.

PURPOSE: Less invasive surfactant administration (LISA) uses a thin catheter that allows infants to breathe spontaneously throughout surfactant administration. The procedure potentially reduces adverse effects and enhances clinical outcomes compared to the INtubate, SURfactant, Extubate (INSURE) method, which requires transient intubation with an endotracheal tube and positive pressure ventilation. The purpose is to share how the Plan-Do-Study-Act (PDSA) cycle method can identify improvement opportunities, guide interventions, and improve outcomes in a LISA quality improvement (QI) initiative via interprofessional collaboration.

METHODS: A QI project was implemented via an interprofessional team using PDSA cycles in a 63-bed level III neonatal intensive care unit. Compliance rates, infant outcomes, and clinician feedback were analyzed and discussed monthly. An interprofessional team developed a step-by-step LISA checklist and LISA video, improved equipment storage, standardized charting, and rolled out re-education.

RESULTS: Implementation of this quality project increased compliance levels of LISA (16 infants pre-project, 43 infants post-project) in place of INSURE (16 infants pre-project, 4 post-project) from 47% to a consistent 100% for eligible infants by 2 months after the project implementation. It also improved multiple outcome measures for the LISA procedure, including a reduction of grade III and IV intraventricular hemorrhage (IVH), a decrease in the percentage of infants requiring a second surfactant dose, and a decrease in chronic lung disease (CLD). LISA was expanded to other hospitals in the physician group's network.