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Show Implementation of a Coarctation Watch clinical practice guideline: A quality improvement project Madeline Park, BSN, RN; Whitnee Hogan, MD, Fetal Heart Director; Julieanne Schiefelbein, DNP, MAppSc, MA (ED), NNP, PNP Key Take Away: A standardized clinical practice guideline .for Coarctation Watch in infants >35 weeks is feasible, usable and acceptable, ongoing collaboration with key stakeholders is crucial for successful sustainability Background Coarctation of the Aorta with PDA open Coarctation of the Aorta with PDA closed • Coarctation of the aorta (CoA) is a ductusdependent type of congenital heart disease (CHD) described by narrowing in the aortic isthmus (Thomas et al., 2024). • CoA occurs in about 1 in every 1,800 babies born in the United States each year (Thomas et al., 2024). • The prenatal diagnosis and management of critical neonatal CHD has been shown to reduce the risk of perioperative morbidity and mortality (Donofrio, 2018). • This Doctor of Nursing (DNP) evidence-based quality improvement (QI) initiative aims to design and implement a systematic, evidence-based approach to the care of infants with prenatally suspected coarctation of the aorta. Methods • • • • • • Development of CPG with QI Team Retrospective chart review Pre-implementation survey Education presentations PDSA cycle (for rapid cycle changes over 8 weeks) Post-implementation survey • • • • • Purpose • Results Benefits of implementing CPG: consistency, earlier detection and treatment, decreased length of stay, feeding faster, preventing NEC, improved staff knowledge, reduced errors, reuniting families sooner, clear orders for bedside RNs 52.6 % of providers found the CPG feasible 61.1 %. Of providers found the CPG usable 77.8 % of providers are satisfied with the CPG Barriers: 21.1% did not know there was a new Clinical practice guideline, 5.3% could not locate the clinical practice guideline Suggestions: collaboration with cardiology, clear identification of risk stratification, improved communication on implementation of the guideline, more RN education, and having a central known location for accessing the guideline Conclusions Variations in practice prior to guideline implementation • Satisfaction with guideline • • • • Yes (65, 67.7%), No (1, 1.0%), Unsure (30, 31.3%) Agree (14, 77.8%), Somewhat agree (1, 5.6%), Neutral (3, 16.7%), Disagree (0, 0.0%) Limitations: response rate of less than 50% for the preimplementation survey and only 16.5% response rate for the post-implementation survey. And QI project's implementation duration Standardization of initial clinical care 100% of caregivers seeing the benefit of a CoA clinical practice guideline Increase RN, NNP, MD understanding of CoA, thus Improving care for infants with suspected CoA Better distribution of the guideline, clear risk stratification, and more education @uofunursing @utnurseresearch |
