Table 1 Key metrics for the adoption of and adherence to monitoring neonates and managing apnoea of prematurity (AOP) with caffeine citrate

Description of metrics to be measured key quantitatively measurable outcomes

a. Adoption of neonate monitoring devices

i. Percentage of eligible neonates connected for continuous and intermittent vital signs monitoring

ii. Percentage of neonates at risk of AOP connected to continuous/intermittent vital signs monitor

iii. Duration between neonates’ first dose of caffeine citrate and connection to continuous vital signs monitor

iv. Duration monitored while on caffeine and on discontinuation where applicable (beyond would be for other reasons)

v. Alarm triggered, response times, type of intervention, e.g. escalation of care/stimulation, cardiopulmonary resuscitation, etc

b. Adherence to monitoring neonates

i. The percentage of time neonates are connected to continuous vital signs monitoring while at NBU

ii. Average Perfusion index (Pi) as per vital sign monitoring device

iii. Number of customised alarm limits (high/low HR, RRp, temp and low SpO₂) per neonate

iv. Number of alarms triggered by the device (for each vital sign, and total)—clinician response time and intervention

v. Length of time (in seconds) between alarm triggering and alarm is silenced or cancelled via vital signs monitor (for each vital sign, and total)

c. Adoption of managing AOP with caffeine citrate

i. Percentage of neonates at risk of AOP receiving caffeine citrate

d. Adherence to managing AOP with caffeine citrate

i. Did the neonate have a new or ongoing caffeine citrate or aminophylline prescription during the 24 time period of interest?

ii. Number of doses of caffeine citrate given in the previous 24-h period

iii. Were caffeine citrate/aminophylline doses missed?

iv. Why were doses missed?

v. Adverse events and comorbidity

Note: Sub-group analysis by each room in the New-born Unit depending on the intensity of care required for all above metrics will be performed

Description of metrics to be assessed qualitatively

1. Adaptability: ability to adapt the apnoea of prematurity clinical care bundle to local needs

2. Appropriateness: alignment of the apnoea of prematurity clinical care bundle with organisational and individual values, mission, and priorities

3. Complexity: degree of difficulty or effort in administering different components of the apnoea of prematurity clinical care bundle. Identify how difficult various clinicians feel it is to administer the apnoea of prematurity clinical care bundle

4. Culture: political, economic, or institutional norms, values, or assumptions influencing the adoption of the apnoea of prematurity clinical care bundle

5. Acceptability: stakeholder satisfaction with the apnoea of prematurity clinical care bundle