Quality improvement for neonatal nurses, part II: using a PDSA quality improvement cycle approach to implement an oral feeding progression guideline for premature infants

Neonatal Netw. Jul-Aug 2012;31(4):215-22.


The development of clinical practice guidelines involving multiple health care providers presents a challenge in the neonatal intensive care unit (NICU). Implementation and evaluation of the guideline is as important as the development of the guideline itself. We explored the use of a quality improvement approach in the implementation of a feeding framework. A Plan-Do-Study-Act (PDSA) quality improvement cycle model was used to implement and evaluate a stepwise oral infant feeding guideline with emphasis on parent and care provider satisfaction. Three PDSA cycles were conducted, with each cycle resulting in modifications to use of the framework and development of knowledge translation and parent education techniques and tools. A PDSA cycle approach can be used effectively in guideline implementation and evaluation involving multidisciplinary health care professionals. This is Part II of a two-part series. Part I introduced the concept of quality improvement and tools for advancing practice changes.

Publication types

  • Evaluation Study

MeSH terms

  • Attitude of Health Personnel
  • Attitude to Health
  • Bottle Feeding
  • Breast Feeding
  • Enteral Nutrition / methods
  • Enteral Nutrition / standards*
  • Focus Groups
  • Humans
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care, Neonatal / methods
  • Intensive Care, Neonatal / standards*
  • Neonatal Nursing / methods
  • Neonatal Nursing / organization & administration
  • Neonatal Nursing / standards*
  • Parents / education
  • Practice Guidelines as Topic*
  • Professional-Family Relations
  • Program Evaluation
  • Quality Improvement / organization & administration*
  • Surveys and Questionnaires