International Journal for Quality in Health Care, 2018, 30(8), 642–648 doi: 10.1093/intqhc/mzy123 Advance Access Publication Date: 8 June 2018 Quality in Practice Quality in Practice Targeted educational program improves infant positioning practice in the NICU LAMA CHARAFEDDINE 1 , SAADIEH MASRI 1 , PERLA IBRAHIM 2 , DANIEL BADIN 3 , SALAM CHEAYTO 4 , and HANI TAMIM 5 1 Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon, 2 School of Medicine, Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon, 3 Department of Biology, Faculty of Arts and Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon, 4 Department of Nursing, American University of Beirut, PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon, and 5 Department of Internal Medicine Clinical Research Institute, Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon Address reprint requests to: Lama Charafeddine, Department of Pediatrics and Adolescent Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon. Email: lc12@aub.edu.lb Editorial Decision 8 March 2018; Accepted 17 May 2018 Abstract Quality problem or issue: Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses’ and doctors’ proficiency in applying proper infant positioning. Initial assessment: Nursing compliance with proper positioning is suboptimal due to many fac- tors. One factor was the inadequate knowledge and practice of infant positioning, since the base- line mean IPAT score was 3.4. Choice of solution: Three experienced neonatal intensive care unit (NICU) nurses were chosen as pos- ition champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice. Implementation: Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants’ positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle’s achieved results. Evaluation: Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention. Lessons learned: A systematic approach targeting infants’ positioning succeeded in improving nurses’ and residents’ clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors. Key words: infant position assessment tool, NIDCAP, prematurity, quality improvement, PDSA Quality problem or issue All infants admitted to the neonatal intensive care unit (NICU), espe- cially those born extremely preterm, are susceptible to musculoskeletal and head deformities due to prolonged periods laying in the supine pos- ition [1, 2]. Studies have shown that lack of supportive positioning may affect infants’ physiologic stability and cause muscle contractures leading to a delay in developmental milestones [3, 4]. Proper positioning has also been shown to positively affect infant quiet sleep and decrease crying episodes [5, 6]. Furthermore, proper positioning promotes flex- ion and midline orientation which prevents asymmetrical posture [7]. © The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 642 Downloaded from https://academic.oup.com/intqhc/article-abstract/30/8/642/5034836 by guest on 06 June 2020