Authors (including presenting author) :
Lee HC(1), Luk CY(1), Kwok HY(1), Cheung SF(1), Ng TK(1), Wong KY(1), Wong SCM(1), Chiu GS(1), Cheung SC(1)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital
Keyword 1: :
Oxygen titration
Keyword 2: :
SpO2 compliance
Keyword 3: :
Hyperoxia reduction
Keyword 4: :
Neonatal Intensive Care Unit
Keyword 5: :
Plan-Do-Check-Act framework
Keyword 6: :
Nurse-initiated program
Introduction :
Oxygen is the most frequently administered medication in NICUs; however, individualized oxygen titration is essential to minimize adverse outcomes. Despite its importance, global compliance with target oxygen saturation remains suboptimal. In 2024, our institution achieved only 54.7% compliance with target oxygen saturation. This quality improvement project aimed to enhance compliance through evidence-based interventions.
Objectives :
(1) To increase the duration of time neonates spent within the target oxygen saturation range by 20% and reduce time spent in hyperoxia; (2) To achieve over 80% accuracy in alarm limit-setting practices; (3) To reduce the incidence of severe retinopathy of prematurity (ROP) by 10%
Methodology :
A pretest–posttest design based on the Plan-Do-Check-Act framework was employed. Neonates requiring oxygen therapy with FiO₂ > 0.21 were included. Outcome measures were (1) the proportion of time within the target SpO₂ range, obtained from the Clinical Information System (CIS); and (2) the accuracy of alarm limit settings, assessed through spot audits. Interventions included an evidence-based titration protocol, nurse education, retrospective chart review on the CIS enhancement, and cue card display.
Result & Outcome :
62 neonates (gestational age 24-41 weeks) were enrolled. The percentage of time within target range increased by 20% (p < 0.001), while hyperoxia decreased from 44.5% to 21.3% (p < 0.001). Alarm-setting accuracy reached 88% Nurses' confidence in guideline application rose from mean 2.63/5 to 4.34/5 (94.1%). Knowledge improved, from 5.9% to 95.6%; correct SpO₂ targeting answers rose to 95-98.5%; hyperoxemia effects recognition increased by 40.3%. A follow-up review from July 1 to September 30, 2025 assessed sustained performance, including 116 neonates (gestational age 23-42 weeks) with 29,996 SpO₂ entries. The overall percentage of time within the target range further improved to 95.02%, with only 1,493 deranged entries (4.98%). This represents a substantial ongoing enhancement from the pre-implementation baseline of 54.7% and the 2024 post-intervention rate of 77.5%. The program also contributed to reduced rates of ROP among neonates. Severe ROP cases decreased from 7.3% (3/41 neonates) in 2023 to 6% (3/50) in 2024, with a relative risk of 0.82 indicating an 18% relative reduction in risk.
