Practice Plan
- Make an organization-wide commitment by administrative, clinical, and patient engagement leaders to address neonatal patient safety related to oxygen administration.
- Assess opportunities to improve oxygen administration and monitoring for the prevention of adverse events due to lack or excess of oxygen.
- Implement interdisciplinary strategies and develop an action plan with a timeline with concrete milestones to implement an optimal oxygen guideline for neonates.
- The SpO2 for a preterm baby breathing supplemental oxygen should not exceed 95%.
- The SpO2 for other larger infants and neonatal patients should stay in the range of 88-95 or 90-96% depending on infant and condition.
- When the saturation or SpO2 dips below 88%, avoid a response that would induce hyperoxia, or high saturation.
- In order to accomplish this, the monitor alarms should always be on and active when an infant is breathing supplemental oxygen or in the neonatal intensive care unit.
- The high SpO2 alarm should be set to 95%, depending on the infant. The low SpO2 alarm should be set to 85%.
- Alarms signaling should receive attention from the nurse/doctor/respiratory therapist.
- When a baby is not breathing supplemental oxygen but is being monitored for desaturations, the low SpO2 alarm should be set at 85% and the high alarm can be turned off.
- Implement your action plan for including educational activities, workshops, and tools for all members of the neonatal healthcare team.
- Develop a process for continuous improvement by communicating with staff and implementing measures to improve processes in order to meet the oxygen targeting objective.
Technology Plan
Suggested technologies are limited to those proven to show benefit or are the only known technologies with a particular capability. As other technology options may exist, please send information on any additional technologies, along with appropriate evidence, to info@patientsafetymovement.org. - Select technologies that have been shown to improve neonatal outcomes, including but not limited to: blenders, pulse oximetry, and heated humidifiers.
- Use blenders in all circumstances when administering oxygen, including the delivery room.
- Bird, Carefusion, Precision Medical’s low-flow and high-flow oxygen-air blenders
- Use heated humidifiers when using CPAP and in all circumstances where the infant is intubated, even for a few minutes.
- Consider using heated humidifiers in the delivery room.
- For pulse oximetry, select equipment that can measure through motion and low perfusion conditions to avoid inaccurate measurements/false alarms and identify true alarms and is proven effective for neonatal oxygen targeting.
- Masimo Signal Extraction Technology (SET) pulse oximetry (until another technology is proven to be equivalent)
Metrics
Topic
Neonatal Oxygen Targeting
Neonatal Oxygen Targeting actively addresses the administration and monitoring of oxygen in newborn infants to prevent both hypoxia and hyperoxia.