Standardization of Resuscitation Carts and Medication Trays in a Level III Neonatal Intensive Care Unit: A Quality Improvement Initiative

Abstract

The CHU Sainte-Justine is a level III university-affiliated mother–child hospital located in Montréal, Québec. Approximately 900 babies are admitted to its 65-bed neonatal intensive care unit (NICU) every year. In 2016, a hospital-wide modernization transformed the NICU into a ward of single-patient rooms, which brought new challenges in the organization of neonatal resuscitation. In addition to the increase in surface area complicating access to the resuscitation carts, the organization and contents of the carts were inconsistent at the time, and the medications available were limited to agents needed for intubation. The multidisciplinary Neonatal Resuscitation Committee undertook the task of developing and implementing standardized resuscitation carts, with the goal of allowing complete resuscitation and initial stabilization of patients. Emergency resuscitations are stressful, and effective and rapid responses are required in these situations. Dangerous medication errors can occur in up to half of the cases involving medication administration in emergency situations.1 The standardization and systematic organization of resuscitation carts could facilitate the process of resuscitation and might even decrease medication errors, potentially improving patient safety. Literature reporting the benefits of using a standardized cart, in terms of the acquisition time for supplies and ease of use, is scarce.2-5 The current report describes the implementation of new standardized carts and medication trays in a NICU, the impact of these changes on clinical care, and staff perceptions of this quality improvement initiative.