Publication:

Improving positioning practices in preterm neonates: a point-of-care quality improvement initiative

Background Optimum positioning is one of the core components of developmental supportive care (DSC). Preterm neonates lack sufficient neurological and musculoskeletal maturity and are at risk of developing misalignment, skeletal deformation, and gross motor delay. Maintaining consistent, developmentally appropriate positioning in routine NICU care remains challenging.

Methods The aim of this study is to improve optimal positioning practices by 50% among preterm neonates admitted to the NICU using a structured quality improvement (QI) approach This single-centre QI study was conducted over a 12-week intervention period (1st April to 30th June 2025) following a 4-week baseline assessment (1st March to 31st March 2025). Positioning quality was assessed using the infant positioning assessment tool (IPAT), with scores >8 considered optimal. The point-of-care QI (POCQI) model was applied, and five plan-do-study-act (PDSA) cycles were implemented. Interventions included nurse training, provision of linen to create nesting boundaries, use of appropriately sized diapers, reinforcement of correct positioning practices, and training mothers in proper positioning practices

Results During the baseline phase, the mean IPAT score was 6.7, and 30% of preterm neonates achieved mean IPAT score more than 8. Following the interventions, the mean IPAT score increased to 10.2, with 86% of preterm neonates achieving mean IPAT score more than 8, demonstrating a significant improvement in positioning practices.

Conclusions This study shows that simple, low-cost, and collaborative interventions can effectively improve positioning practices in preterm neonates. Incorporating structured QI strategies into routine NICU care may enhance delivery of DSC.