Implementation of Less Invasive Surfactant Administration (LISA) for Preterm Neonates with Respiratory Distress Syndrome: A Quality Improvement Initiative.

objectivesTo initiate less invasive surfactant administration (LISA) in authors' unit using a quality improvement (QI) approach and increase LISA rates by 50% over 10 mo period.

methodsThe authors adopted a QI methodology to address this issue. The proportion of surfactant administration done by the LISA method was the primary outcome indicator. Focused group discussions were conducted with doctors and nurses during the initial phase to identify the root causes. Meetings were conducted where team members were given descriptions of the insertion method, complications and precautions to be taken. All the members were trained to use LISA on mannequins in a simulation lab. They were also trained regarding the fixation of continuous positive airway pressure (CPAP), monitoring of complications and correction steps. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented. A standard operating policy was developed, and all babies requiring surfactant were administered surfactant with the LISA technique.

resultsOver the 10 mo, the proportion of neonates who received surfactant via the LISA method increased from 0 to 90%. Complications such as desaturation (74%), surfactant reflux (32.1%), bradycardia (25%), and unilateral administration of surfactant (26.7%), which were initially observed, gradually decreased to 7.4%, 3.7%, 7.4%, and 7.4%, respectively.

conclusionsUtilising QI tools, the authors achieved an increase in the rate of surfactant administration by the LISA method by more than 50%.