Using Evidence Based Practice to Reduce Incidence and Severity of Retinopathy of Prematurity (ROP) in the NICU

Evidence suggests a correlation between oxygen saturation in preterm babies and Retinopathy of Prematurity (ROP).  Recognizing that there were disparities in oxygen management practices, the Holy Cross Hospital NICU staff implemented an EBP guideline based on a Cochrane Systematic Review for this practice. An oxygen administration tool was developed that standardized oxygen saturation ranges and delivery to this at risk group.  In November 2005, the Vermont Oxford Consortium showed an upward trend in the cases of moderate to severe ROP.   This coincided with nation-wide implementation of revised ROP treatment protocols and the increased survivability of the extremely premature infants.  Several staff attended conferences and heard about how other institutions had positively impacted patient outcomes.   In January 2006, the unit’s practice council developed a PICO question, conducted a gap analysis, knowledge assessment and a perception inventory to understand the scope of the issue. Based on the evidence, an ROP Risk Assessment Tool and Protocol was developed and utilized at change of shift report to facilitate the change in practice.  Data collection started in February 2006. To establish practice, data was initially collected on all NICU patients. After two months, data collection was focused on babies less than 34 weeks who are most at risk. To monitor compliance, completion of the risk assessments was audited and data reported via dash board format at staff meetings and posted on the unit. The compliance percentages were set at > 85% green, 84-50% yellow, and <50% red.  Outcome data is reported to the Vermont Oxford Consortium to provide benchmark information with other neonatal intensive care units.  In February 2006 results (n=469) were in the red and for all 4 indicators.  Ongoing education and utilizing change strategies brought improvement in August 2006.  Indicators continue to be maintained at  >85% for over one year indicating implementation of the ROP protocol into practice. Initial outcome data indicate an improvement by the reduction in the number of infants requiring treatment for retinopathy.