Standardizing premedication for non-emergent neonatal tracheal intubations improves compliance and patient outcomes

Objective We sought to standardize and improve compliance with evidence-based premedication for non-emergent neonatal intubations in two academic-affiliated Neonatal Intensive Care Units. Study design A multidisciplinary team created guidelines and electronic medical record order sets for intubation. Compliance with recommended premedication, number of intubation attempts, and frequency of bradycardia and desaturation were assessed. Results 387 intubation procedures were reviewed. Provision of recommended premedication increased by 36% and 75% at the level III and IV units, respectively. Decreased frequency of bradycardia during intubation ( p = 0.0003) occurred in the level III unit. A reduction in number of intubation attempts ( p ≤ 0.001), improvement in first-attempt intubation success ( p ≤ 0.001), and decreased frequency of bradycardia ( p = 0.01) and desaturation ( p = 0.02) during intubation occurred in the level IV unit. Conclusions This quality improvement initiative improved standardized premedication compliance and decreased adverse events associated with non-emergent neonatal intubations in two separate units.