Quality Improvement Project: The Development of a Feeding Guideline for Neonates with Gastroschisis

Background: Gastroschisis is the most common abdominal wall defect treated in the neonatal intensive care unit (NICU). Well-defined standardized gastroschisis guidelines, multidisciplinary team collaboration during guideline development, and sufficient guideline directives regarding feeding progression decreases practice variation and enhances healthcare providers' adherence. Local Problem: The lack of standardized feeding guidelines for patients with gastroschisis, consistency of care in a level IV NICU increase these patients' risk for potential healthcare complications. There was a need for the development of standardized gastroschisis guidelines to enhance these patients' consistency of care. This project advocates for both consistency in the management of these patients' care and multidisciplinary team engagement in a level IV NICU through the development and implementation of a gastroschisis guideline. Methods: The study was conducted using a retrospective chart review of 64 patients with simple gastroschisis to evaluate the patients' consistency of care. Retrospective data review combined with current evidence-based data were utilized for the development of a gastroschisis management guideline. Interventions: Educational sessions about the developed gastroschisis guideline and evidence supporting it were presented to multidisciplinary members before guideline implementation. A pre-education and guideline implementation survey evaluated healthcare providers' knowledge regarding benefits and complications associated with the lack of standardized gastroschisis guidelines and assessed staff awareness of current practices in a level IV NICU. A chart review and one Plan, Do, Study, Act (PDSA) cycle were performed to evaluate adherence of healthcare providers to the new guideline, and a post-survey questionnaire was conducted after 3 weeks of guideline implementation to determine the effectiveness of education, usability, and satisfaction of the healthcare providers to the developed guideline. Results: Post-implementation findings indicated that approximately 88 percent (n=60) of providers understood that the development of standardized feeding guidelines improves patients with gastroschisis outcomes. Providers' understanding of the importance of standardized guidelines for infants with gastroschisis increased (p < .05). Post-survey data indicated that 88.2% (n=60) of providers strongly agree or agree with the developed guideline compared to 11.8% (n=8) of providers that neither agree nor strongly disagree with the new practice. PDSA cycle findings suggest healthcare providers' need for reviewing the developed guideline information to ensure practice consistency. Conclusion: Educational presentations, gastroschisis guideline development, and collaboration by multidisciplinary team members improved healthcare providers' engagement and understanding of the importance of standardized guidelines. Due to the small patient sample after practice guideline implementation, one PDSA cycle was not enough to determine healthcare providers' utilization of the developed guideline.