Operational Excellence

Document Type


Publication Date



Pediatrics, Maine Medical Center

MeSH Headings

neonates, intubation, patient, ventilation, non-invasive, root cause analysis, environment, NICU, survey


Premature neonates born before 26 weeks gestation present many care challenges as they need special precautions to be taken to overcome their fragility. Intubation is often needed for this patient population as their lungs are not fully developed. However, due to their high susceptibility for skin breakdown invasive ventilation often can create subsequent problems. A respiratory therapist team in an academic tertiary medical center wanted to explore the use of an occlusive interface for intubation while providing various forms of non-invasive ventilation in their NICU with the hopes for fewer complications.

The objective of this project was to reduce the incidence of skin breakdown by increasing the use of the new interface (F&P).

A root cause analysis was initiated and a number of concerns were identified related to current practice and that of proposed practice. These included that of environment, neonate skin integrity, staff education, communication, and assessment requirements. Several countermeasures were implemented such as surveys for NICU staff to identify barriers to the use of an occlusive interface as well as development of educational tools to address concerns raised by the survey. A mandatory competency was also developed.

Data was collected 4 months prior to project start and was compared to data 4 months after project start. This comparison demonstrated an outcome of increased use in F&P.

Next steps include continued monitoring of compliance and education via several avenues.

Included in

Pediatrics Commons



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