Authors (including presenting author) :
Wong KY(1), Sin KWK(1), Tong CHC(1), Chan HTI(2)
Affiliation :
(1) Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital (2) Department of Obstetrics & Gynaecology, Queen Mary Hospital
Keyword 1: :
Preterm Infant
Keyword 2: :
Clinical Workflow Optimization
Keyword 3: :
Interdepartmental Coordination
Keyword 4: :
Vitamin K Prophylaxis
Introduction :
To prevent vitamin K deficiency bleeding (VKDB), global guidelines recommend all newborns should receive Vitamin K prophylaxis shortly after birth, while some guidelines permit delaying administration up to 6 hours to facilitate breastfeeding and skin-to-skin contact. . Preterm infants are at higher risk of VKDB of due to liver immaturity and delayed gut colonization, so they require prompt vitamin K prophylaxis. Previously, vitamin K administration for preterm infants was dependent on the receipt of the MAR and transfer documents from labor ward. Our cross-departmental CQI initiative redesigned this workflow to enable timely prophylaxis.
Objectives :
(1) To reduce the median waiting time for preterm infants< 34 weeks in vitamin K administrations by 20% (2) To ensure no medication incident related to vitamin K administration for newborn preterm infants
Methodology :
A cross-departmental workgroup is formed to discuss the optimization of workflow of vitamin K administration and target group of this project. The workgroup agreed to change the workflow to allow MAR to be given to NICU nurses on admission of preterm infants with gestational age < 34 weeks, instead of transported from labour ward with other transfer paperwork afterwards. All neonatal doctors, nurses from NICU and labour ward were informed of the new updated workflow and it was implemented since 25th Mar2025. A retrospective record review was performed to compare time from birth to vitamin K₁ administration. A total of 22 records from before and 24 records from after the new workflow implementation were reviewed.
Result & Outcome :
The median time from birth to vitamin K administration reduced from 121 minutes to 83 minutes after implementing the updated workflow, which is a 31.4% time reduction. (p=0.0062). There is no medication incident related to vitamin K administration for newborn preterm infants after implementation of the updated workflow
