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Phoebe NICU Completes Quality Collaboratives Focused on Micro-Preemies and Antibiotic Stewardship

Albany, Ga. – Phoebe’s Neonatal Intensive Care Unit (NICU) team recently completed a two-year quality initiative aimed at improving outcomes for the tiniest babies they care for. Phoebe’s team worked closely with other neonatology experts from eight hospitals around the country through the Vermont Oxford Network (VON). “You can’t move forward and achieve better outcomes without continuous learning. It’s great to collaborate with larger hospitals and learn from them and to share things we’re doing extremely well at Phoebe,” said Jennifer Hill, RN, Phoebe NICU Nurse Manager.

VON is a worldwide community of healthcare professionals dedicated to improving the quality, safety, and value of care for newborn infants and their families through a coordinated program of data-driven quality improvement, education, and research. Members use confidential information from the world’s largest and most comprehensive databases of infant data to benchmark their practices and outcomes and identify areas for improvement.

Phoebe is one of about 50 hospitals participating in the network at the highest level by committing to be part of a Newborn Improvement Collaborative for Quality (NICQ). “We have a very concerted effort to deliver quality care to every patient. We are focused on consistent, evidence-based care and have outcomes that are very favorable compared to hospitals across this country,” said Jack Owens, MD, Phoebe NICU Medical Director. “Parents can know their babies have as good or better care at Phoebe as anywhere in the country.”

The NICQ in which Phoebe’s NICU participated focused on the care of micro preemies who weigh less than 1000 grams (around 2 pounds 3 ounces) at birth. The work helped the Phoebe team standardize their care during the “golden hour,” the first hour after a baby is born. “We want to make sure we’re doing everything right from the first second,” said Jenny Lawson, RN, Phoebe Women & Children’s Quality Nurse Specialist. “We finished this collaborative, but our learning and quality improvement continue. We’re still doing meaningful work that is going to improve outcomes for babies here.”

That work is also strengthening Phoebe’s team approach. The quality initiative did not just include physicians and nurses. Pharmacists, nutritionists, respiratory therapists, physical therapists, data analysts and more were involved. “The goal is for all involved with the care of our smallest patients to be involved in quality improvement efforts,” Dr. Owens said.

Nearly all the other hospitals in Phoebe’s work group are large children’s hospitals or major academic medical institutions. “We are pushing to stay on the edge of innovation, so these top hospitals will come to us and ask, ‘what can we learn from you,’” Lawson said.

The project allowed Phoebe to compare its quality metrics to those hospitals in its group with world-class reputations. “We were at the head of the pack on major things like death and morbidity.  Other hospitals were surprised at the number of very low birth weight (VLBW) babies we care for and the fact that we care for babies down to 22 weeks. Even many larger hospitals don’t do that,” Hill said.

In 2017 and 2018, Phoebe cared for 292 VLBW babies. Their rates of survival, chronic lung disease, severe retinopathy and other important metrics were significantly better than the Georgia and U.S. averages.  That knowledge has given the already close-knit Phoebe NICU team even greater confidence and pride in their work. “This is the secret sauce of quality improvement. It’s more than data and accountability,” Dr. Owens said. “You have to have common focus and camaraderie. You have to learn together and have a shared vision. We definitely have that in our NICU, and that benefits our patients.”

Phoebe also recently earned designation as a Center of Excellence in Education and Training for Antibiotic Stewardship in Newborn Care from VON. Phoebe enrolled in Choosing Antibiotics Wisely, an international quality improvement collaborative developed by VON in partnership with the Centers for Disease Control and Prevention. “Congratulations to the entire team at Phoebe Putney Memorial Hospital on this impressive accomplishment and for demonstrating sustained commitment to antibiotic stewardship,” said Jeffrey Horbar, MD, Chief Executive and Scientific Officer of VON.

Phoebe’s NICU team joined more than 180 other teams from newborn nurseries, birth centers and NICUs in 38 states and seven countries to employ proven quality improvement methods to implement processes, procedures and tools aimed at using antibiotics more responsibly. Phoebe’s multidisciplinary NICU care team participated in a series of live webinars, developed structured improvement programs, audited their local practice and benchmarked their outcomes with other centers.

Antibiotic misuse in a NICU baby can have a lifelong impact on that patient and can contribute to an overall decrease in the effectiveness of antibiotics for the whole population. The Choosing Antibiotics Wisely collaborative hopes to achieve a 45% reduction in antibiotic use rates by 2022.