Srinivasan Mythili, Pruitt Cassandra, Casey Erin, Dhaliwal Keerat, DeSanto Cori, Markus Richard, Rosen Ayelet
Department of Pediatrics, Washington University, St Louis, Missouri;
Department of Pediatrics, Washington University, St Louis, Missouri.
Hosp Pediatr. 2017 Aug;7(8):436-443. doi: 10.1542/hpeds.2016-0160. Epub 2017 Jul 5.
Intravenous (IV) hydration is used primarily in children with bronchiolitis at our institution. Because nasogastric (NG) hydration can provide better nutrition, the goal of our quality improvement (QI) initiative was to increase the rate of NG hydration in eligible children 1 to 23 months old with bronchiolitis by 20% over 6 months.
We used Plan-Do-Study-Act cycles to increase the use of NG hydration in eligible children. Interventions included educational and system-based changes and sharing parental feedback with providers. Chart reviews were performed to identify the rates of NG hydration, which were plotted over time in a statistical process control p chart. The balancing measure was the rate of complications in children with NG versus IV hydration.
Two hundred and ninety-three children who were hospitalized with bronchiolitis needed supplemental hydration during the QI initiative (January 2016-April 2016). Ninety-one children were candidates for NG hydration, and 53 (58%) received NG hydration. The rates of NG hydration increased from a baseline of 0% pre-QI bronchiolitis season (January 2015-April 2015) to 58% during the initiative. There was no aspiration and no accidental placement of the NG tube into a child's airway. Nine patients (17%) in the NG group had a progression of disease requiring nil per os status, and 6 of these were transferred to the PICU whereas none of those in the IV group were transferred to the PICU. Post-QI initiative, the majority of nurses (63%) and physicians (95%) stated that they are more likely to consider NG hydration in children with bronchiolitis.
We successfully increased the rates of NG hydration in eligible children with bronchiolitis by using educational and system-based interventions.
在我们机构，静脉补液主要用于患细支气管炎的儿童。由于鼻胃管补液能提供更好的营养，我们质量改进计划的目标是在6个月内将符合条件的1至23个月大患细支气管炎儿童的鼻胃管补液率提高20%。
我们采用计划-实施-研究-行动循环来增加符合条件儿童鼻胃管补液的使用。干预措施包括教育和基于系统的改变，以及与医护人员分享家长反馈。进行病历审查以确定鼻胃管补液率，并在统计过程控制p图中随时间绘制。平衡指标是鼻胃管补液与静脉补液儿童的并发症发生率。
在质量改进计划期间（2016年1月至2016年4月），293名因细支气管炎住院的儿童需要补充水分。91名儿童适合鼻胃管补液，其中53名（58%）接受了鼻胃管补液。鼻胃管补液率从质量改进前细支气管炎季节（2015年1月至2015年4月）的基线0%增至计划实施期间的58%。未发生误吸，鼻胃管也未意外插入儿童气道。鼻胃管补液组有9名患者（17%）病情进展需要禁食，其中6名转入儿科重症监护病房，而静脉补液组无人转入儿科重症监护病房。质量改进计划实施后，大多数护士（63%）和医生（95%）表示，他们更有可能考虑对患细支气管炎的儿童采用鼻胃管补液。
我们通过基于教育和系统的干预措施，成功提高了符合条件的患细支气管炎儿童的鼻胃管补液率。
