LAUSR

OBJECTIVE To improve the utilization of amplitude-integrated electroencephalography (aEEG) in a neonatal unit by improving aEEG documentation, aEEG knowledge and pattern recognition ability of neonatal staff. METHODS A quality improvement (QI) program comprising two plan-do-study-act (PDSA) cycles was conducted in a level 3 neonatal intensive care unit. The first cycle was focused on improving aEEG documentation with the primary outcome indicator being compliance with aEEG documentation. The second cycle was focused on aEEG interpretation in a healthcare professional education program with the outcome indicators being accuracy of seizure identification on aEEG and change in conventional EEGs (EEG) performed. Other outcome indicators included accuracy in identification of background pattern, sleep-wake cycles and artefacts. Process indicators included improvement in aEEG-related knowledge. INTERVENTIONS First PDSA cycle - lectures on aEEG interpretation, a bedside key and documentation form. Second PDSA cycle - online aEEG education pack, detailed aEEG guideline. RESULTS There was a significant improvement in aEEG documentation after the implementation of both PDSA cycles. 7 of the 46 patients (15.2%) had isolated electrographic seizures which would not have been identified in the pre-aEEG monitoring era. There was an increase in the number of patients with EEGs done, but a steady decrease in number of EEGs per patient. CONCLUSIONS With the successful application of standardized QI methods, improvements in outcome indicators such as correct aEEG pattern recognition and improved coverage of at risk infants with EEGs were observed. Our QI measures were associated with improvement in aEEG pattern recognition.