Collaborative Work with VON 1995 to 2003

Another important factor in the DHMC ICN's quest for best possible care has been the ICN's participation in the Vermont Oxford Network. In 1994, VON initiated a focus on collaborative, multidisciplinary quality improvement, with the DHMC ICN as a charter member (Horbar et al., 2001; Rogowski et al., 2001). Approximately 100 ICNs worked together, either directly or via teleconferencing, to improve the quality of neonatal care.

By working with VON the ICN at DHMC was able to

• Reduce its nosocomial infection rate by approximately 70 percent in three years, from an annual rate of 39 percent to 13 percent among infants with birth weights ranging from 501 to 1500 grams.

• Help plan and colead an international, multicenter, randomized controlled trial on the effectiveness of prophylactic skin care with an emollient on nosocomial infection rates and skin integrity in extremely low birth weight infants (501 to 1,000 grams) (Edwards, Conner, & Soll, 2001, 2004).

• Improve use of nasal continuous positive airway pressure (CPAP) by benchmarking the best-known practices and best-observed outcomes and applying these practices and outcome measures. This activity led to large measurable improvements—for example, a substantial decline in the mean number of days that infants used mechanical ventilation (see Figure 2.4).

• Colead and participate with ten other centers in a program to increase family involvement in each child's care, which involved including parents, as members

FIGURE 2.4. LONGITUDINAL TRENDS IN NUMBER OF DAYS ICN INFANTS SPEND ON MECHANICAL VENTILATION.

Mechanical Ventilation Birth Weight 401-1500 gm

FIGURE 2.4. LONGITUDINAL TRENDS IN NUMBER OF DAYS ICN INFANTS SPEND ON MECHANICAL VENTILATION.

Mechanical Ventilation Birth Weight 401-1500 gm

Date of Birth

+ Deaths of the care team, in daily rounds (Cisneros-Moore, Coker, DuBuisson, Swett, & Edwards, 2003; Saunders, Abraham, Crosby, Thomas, & Edwards, 2003). • Experience the power and attractiveness of learning from and with others in a community of practice (Wenger, 1999).

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