Challenge 7A

Suboptimal Neonatal Oxygen Targeting

Executive Summary Checklist

Hypoxia in pre-term infants can result in mortality. Supplemental oxygen administration helps avoid hypoxia but hyperoxia can cause retinopathy of prematurity and increase risk for other conditions. Implementing an optimal oxygen targeting policy can improve neonatal outcomes. To address suboptimal oxygen targeting:

  • Make an organization-wide commitment by administrative, clinical, and patient engagement leaders to address neonatal patient safety related to oxygen administration.
  • Assess opportunities to improve oxygen administration and monitoring for the prevention of adverse events due to lack or excess of oxygen.
  • Implement interdisciplinary strategies and develop an action plan with a timeline with concrete milestones to implement an optimal oxygen policy for neonates.
  • Select technologies that have been shown to improve neonatal outcomes, including but not limited to: blenders, pulse oximetry, and heated humidifiers.
  • Determine the oxygen targeting policy that healthcare providers should implement:
    • The SpO2 for a pre-term baby breathing supplemental oxygen should not exceed 95%.
    • The SpO2 for other larger infants and neonatal patients should stay in the range of 88-95% or 90-96% depending on infant and condition.
    • When the saturation or SpO2 dips below 88%, avoid a response that would induce hyperoxia, or high saturation.
    • In order to accomplish this, the monitor alarms should always be on and active when an infant is breathing supplemental oxygen.
    • The high SpO2 alarm should be set to 95%, depending on the infant. The low SpO2 alarm should be set to 85%.
    • Alarms signaling should receive attention from the nurse/doctor.
    • When a baby is not breathing supplemental oxygen but is being monitored for desaturations, the low SpO2 alarm should be set at 85% and the high alarm can be turned off.
  • Implement your action plan for including educational activities, workshops, and tools for all members of the neonatal healthcare team.
  • Develop a process for continuous improvement by communicating with staff and implementing measures to improve processes in order to meet the oxygen targeting objective.

Between the 2017 World Patient Safety, Science & Technology Summit and the 2017 Midyear Planning Meeting a workgroup comprised of experts representing administrators, clinicians, technologists and patient advocates will meet to update this APSS. If you are interested in joining this workgroup, please email us.

Parent Challenge

  1. Challenge 7: Neonatal Safety