Balakrishnan M, Falk-Smith N, Detman L A, Miladinovic B, Sappenfield W M, Curran J S, Ashmeade T L
Division of Neonatology, Department of Pediatrics, University of South Florida Health, Tampa, FL, USA.
Lawton and Rhea Chiles Center for Healthy Mothers and Babies, Department of Community and Family Health, College of Public Health, University of South Florida Health, Tampa, FL, USA.
J Perinatol. 2017 Jul;37(7):886-892. doi: 10.1038/jp.2017.27. Epub 2017 Apr 13.
LOCAL PROBLEM: Inadequate understanding of compliance with standardized evidence-based DR management.
Promote inter-professional teamwork and a bundle of interventions focusing on resuscitation team roles, equipment check, and debriefing using QI methodology. Optimize delivery room (DR) management to achieve 10-min SPO targets, delayed-cord clamping (DCC), team role assignment and debriefings in >50% of deliveries, and achieve normothermia in >75% of infants.
Over 15 months (Epoch 1 to 5), nine Florida hospitals implemented a DR management plan for infants <31 weeks gestational age or <1500 g (N=814) using quality improvement methodology.
There was increased compliance of DCC (36 to 66%), role assignment (53 to 98%), debriefing rates (33 to 76%) and having all seven pre-delivery preparedness components fulfilled (34 to 75%). There were no significant improvements in admission temperatures or SPO targeting. When 7 vs 0 items of pre-delivery preparedness were completed, we saw improvements in thermoregulation (57% vs 72%), SPO targeting (60% vs 78%) and DCC compliance (43 to 67%).
Promoting teamwork by increasing pre-delivery preparedness is associated with improvement of thermoregulation, SPO targeting and DCC compliance.
局部问题：对标准化循证产房管理的依从性认识不足。
促进跨专业团队合作，并采用质量改进方法开展一系列聚焦复苏团队角色、设备检查及汇报总结的干预措施。优化产房管理，以实现10分钟血氧饱和度（SPO）目标、延迟脐带结扎（DCC）、在超过50%的分娩中进行团队角色分配及汇报总结，并使超过75%的婴儿实现体温正常。
在15个月内（第1阶段至第5阶段），佛罗里达州的9家医院采用质量改进方法，对孕周小于31周或体重小于1500克的婴儿（N = 814）实施产房管理计划。
延迟脐带结扎的依从性有所提高（从36%提高至66%），角色分配（从53%提高至98%）、汇报总结率（从33%提高至76%）以及所有七项分娩前准备内容均完成的情况（从34%提高至75%）也有所改善。入院时体温或血氧饱和度目标方面无显著改善。当完成7项而非0项分娩前准备项目时，我们发现体温调节（57%对72%）、血氧饱和度目标（60%对78%）和延迟脐带结扎依从性（43%至67%）有所改善。
通过增加分娩前准备来促进团队合作与体温调节、血氧饱和度目标及延迟脐带结扎依从性的改善相关。
