ROP reduction
task force members
VICTORIA DEL VALLE,
MSN, RNC-NIC, CNS
Team lead
HEATHER
HASTINGS, RN
ALYSON BRODEY
Neonatal Practitioner
SHARON ENOCH
Linical Education Specialist
SUSAN PARKER
Associate Clinical Manager
ELLEN MILLER, MD
Ophthalmologist
MARY LAIRD, MD
Neonatologist
EXEMPLARY PROFESSIONAL PRACTICE
Reducing Severe Retinopathy
of Prematurity in the NICU at
Colorado Springs
Most retinopathy of prematurity (ROP), a complication of prematurity, resolves
spontaneously. However, patients with severe ROP are at increased risk for poor
ocular outcomes with vision impairment. In fact, ROP is the leading cause of
childhood blindness in the U.S.
In 2017, our Neonatal Intensive Care Unit in Colorado Springs experienced an
alarming increase in laser surgery for ROP, and our severe ROP rate went up from
2016. Our Colorado Springs NICU had the second-highest severe ROP (defined as
stage 3 ROP warranting treatment) rate among 50 high-volume NICUs, with 109
percent increase in laser surgery by mid-2017.
In 2018, the NICU team launched a quality improvement project to reduce severe
ROP to a level below the national average. The specific aim was to reduce severe
the rate by 30 percent, from the 2017 baseline rate of 13.9 percent to 9.8 percent by
December 2018.
A multidisciplinary team studied the literature and invited pediatric ocular
specialist Scott Oliver, MD, to share his expertise. Through this collaboration, the
team developed key drivers and interventions, such as establishing and maintaining
target pulse-oximetry range, setting correct alarm limits and establishing
a protocol to reduce fluctuation of saturations, as well as ROP awareness,
staff education and family involvement. The team used a Plan-Do-Study-Act
methodology for this work.
Although our severe ROP rate rose to 15.6 percent in 2018, we had 45 percent fewer
cases of laser surgery compared to 2017, due to the interventions put in place to
halt the progression of ROP.
PASTORA
GARCIA-JONES, MD
Neonatologist
34
Clinical Expertie and Programs | 35