Necrotizing Enterocolitis Toolkit: Quality Improvement in the Neonatal Intensive Care Unit

Background: Necrotizing Enterocolitis (NEC) is a devastating illness in the neonatal population. Despite decades of research, the pathology of NEC is not fully understood, and 90% of incidences occur in premature neonates. It is unclear if healthcare providers are aware of the risk factors that place neonates at an increased risk for developing NEC. This project enhanced the education and communication of healthcare providers to improve outcomes and decrease incidences of NEC at a Level III neonatal intensive care unit (NICU) in the Intermountain West. Methods: This survey-based quality improvement project assessed the providers current knowledge about the risk factors of NEC and evaluated their feeling about communication among the health care providers in the neonatal unit. Prior to creating the NEC toolkit, the Vermont Oxford Network (VON) database was used to identify all patients in this unit who had been diagnosed with NEC from January 2019 - February 2022. Detailed chart reviews were completed on each patient, including demographics, risk factors, and other reviewed statistics. All information collected was used to create the NEC toolkit and educational PowerPoint. Education was provided to the providers prior to implementation, and a post-education survey was used to assess any change in providers knowledge 40 days after the implementation of this project. The results from the pre-and-post implementation surveys were compared to understand a change in knowledge of NEC, neonatal risk factors, and communication between providers and with parents, as well as the feasibility, useability, and satisfaction of this project. Results: After the education was provided to all providers within this NICU and implemented into the daily workflow, the post-education survey shows an overall improvement in providers ability to identify risk factors, signs, and preexisting factors related to NEC in the NICU. Additionally, there was an increase in effective communication among healthcare providers, pre- education 27% (n=27) to post-education 93% (n=7). Chart reviews indicated that 46% (n=26) of patients who developed NEC did not follow the unit's feeding guideline, and 49% (n=28) had discrepancies in bedside and advance provides electronic health record (EHR) documentation. Conclusions: The education and NEC toolkit was well received by the healthcare providers and appeared to be an effective resource to increase knowledge and understanding of NEC and improved communication among bedside and advanced providers. Implementation of the NEC toolkit within the NICU may reduce the number of neonates affected by NEC by providing continued education to bedside and advanced providers.