Nasogastric Hydration for Bronchiolitis: Sustaining Change in Practice

Abstract

The success of a quality improvement (QI) project depends not only on the implementation of the initiative but also on the sustainability of the changes. 1 While there is large body of literature showing the successful implementation of QI initiatives in hospitals across the nation, reports showing sustainability in follow-up periods are often not available. 1 We implemented a QI initiative to increase the rate of nasogastric (NG) hydration in children with bronchiolitis from January to April 2016. 2 The rationale for the initiative was that NG hydration, compared with intravenous (IV) hydration, can provide better nutrition since breast milk or formula can be given via NG tube. Decreased nutritional intake early in the hospital course has been associated with a longer length of stay in infants with bronchiolitis. 3,4 Increased protein energy intake in critically ill infants with bronchiolitis promotes anabolism, an important goal of nutritional support of sick children. 5 Our initiative was successful in increasing rates of NG hydration in eligible children from 0% to 58% in 6 months. 2 We sought to determine if this change could be sustained without further interventions.