Tartaglia Kimberly M, Campbell Jessica, Shaniuk Paul, McClead Richard E
Department of Pediatrics and Internal Medicine, Wexner Medical Center, The Ohio State University, Nationwide Children's Hospital, USA.
Hosp Pediatr. 2013 Jul;3(3):251-7. doi: 10.1542/hpeds.2012-0103.
The goal of this study was to improve compliance with published guidelines regarding management of neonatal hyperbilirubinemia in infants admitted to a general pediatric hospital ward and to improve support for their breastfeeding mothers.
This quality improvement project was conducted by using Plan-Do-Study-Act cycles and statistical process control methods. Study subjects were infants > 35 weeks' gestation admitted for hyperbilirubinemia to the general inpatient ward of a large, freestanding pediatric hospital. We developed and implemented a guideline for the inpatient management of jaundiced neonates, with ongoing feedback given to the faculty on group performance. Outcome measures included monthly compliance scores based on American Academy of Pediatrics (AAP) guidelines for management of neonates > 35 weeks' gestation and the percentage of admitted jaundiced, breastfeeding infants whose mothers received lactation consultation during hospitalization. To determine the AAP compliance score, we reviewed and assigned points to each patient admission for completion of a standard evaluation, avoidance of unnecessary intravenous (IV) fluids and peripheral IV line placement, avoidance of rebound bilirubin checks while in the hospital, and the bilirubin level at discharge.
Mean monthly AAP compliance scores increased from 60.5% of total possible points during the baseline period (January 2010-December 2010) to 90.4% during the intervention period (January 2011-December 2011). Lactation consultations increased from 48% during our baseline period to 63% during our early intervention period and to 90% during the last 5 months of our intervention. Length of stay was unchanged during the baseline and intervention periods.
Interprofessional collaboration between nurses and physicians combined with a thoughtful campaign to increase awareness of published guidelines were successful in improving the care of infants admitted with unconjugated hyperbilirubinemia.
本研究的目的是提高综合性儿科医院病房收治的婴儿在新生儿高胆红素血症管理方面对已发表指南的依从性，并加强对其母乳喂养母亲的支持。
本质量改进项目采用计划-执行-研究-行动循环和统计过程控制方法开展。研究对象为妊娠35周以上因高胆红素血症入住大型独立儿科医院普通住院病房的婴儿。我们制定并实施了一项黄疸新生儿住院管理指南，并持续向医护人员反馈团队表现。结果指标包括根据美国儿科学会（AAP）针对妊娠35周以上新生儿管理指南得出的月度依从性评分，以及住院期间入住的黄疸母乳喂养婴儿的母亲接受泌乳咨询的比例。为确定AAP依从性评分，我们对每位入院患者进行审查并打分，评估标准包括完成标准评估、避免不必要的静脉输液和外周静脉置管、避免住院期间进行反弹性胆红素检查以及出院时的胆红素水平。
月度AAP依从性评分均值从基线期（2010年1月至2010年12月）占总分的60.5%增至干预期（2011年1月至2011年12月）的90.4%。泌乳咨询比例从基线期的48%增至早期干预期的63%，并在干预期的最后5个月增至90%。基线期和干预期的住院时长未变。
护士与医生之间的跨专业协作，加之一场旨在提高对已发表指南认识的精心活动，成功改善了对因非结合性高胆红素血症入院婴儿的护理。
