Impact of inhaled nitric oxide stewardship programme in a neonatal intensive care unit

Abstract

Aim:Inhaled nitric oxide (iNO) is the most common, although expensive, therapy for persistent pulmonary hypertension of the newborn andhypoxaemic respiratory failure. With significant variation in iNO delivery practices amongst clinicians, this study aimed to assess the effectivenessof a stewardship programme in increasing clinician compliance with revised, standardised protocols and to measure the impact of compliance oniNO therapy use.Methods:Initiation and weaning protocols for iNO were introduced to the neonatal intensive care unit at The Centenary Hospital on 01 March2016. A 2-year stewardship programme was utilised to assess protocol compliance and the resulting iNO usage impacts were measured. A com-bined retrospective and prospective study from 1 March 2014 to 28 February 2018 was conducted to compare the patterns of iNO utilisationbetween the pre- and post-stewardship cohorts.Results:The pre-stewardship cohort incorporated 18 neonates, receiving 19 iNO treatment episodes, and 18 neonates, receiving 21 iNO treat-ment episodes, in the post-stewardship cohort. No significant difference in patient demographics was determined. Compliance with the protocolsimproved from 61% in year 1 to 88% in year 2 of the stewardship programme. Significant reductions were observed in median total hours of iNOtherapy per patient (P= 0.0014) and in median time from therapy initiation to initial wean (P< 0.0001). The cost of iNO therapy reduced 52% dur-ing the stewardship programme with no increase in adverse patient outcomes.Conclusion:An iNO stewardship programme could be safely implemented in any NICU leading to increased protocol compliance with a benefi-cial reduction in iNO usage and cost. Show more