Graham Hamish R, Bakare Ayobami A, Gray Amy, Ayede Adejumoke Idowu, Qazi Shamim, McPake Barbara, Izadnegahdar Rasa, Duke Trevor, Falade Adegoke G
Centre for International Child Health, University of Melbourne, MCRI, The Royal Children's Hospital, Parkville, Victoria, Australia.
Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
BMJ Glob Health. 2018 Jun 26;3(3):e000812. doi: 10.1136/bmjgh-2018-000812. eCollection 2018.
Pulse oximetry is a life-saving tool for identifying children with hypoxaemia and guiding oxygen therapy. This study aimed to evaluate the adoption of oximetry practices in 12 Nigerian hospitals and identify strategies to improve adoption.
We conducted a mixed-methods realist evaluation to understand how oximetry was adopted in 12 Nigerian hospitals and why it varied in different contexts. We collected quantitative data on oximetry use (from case notes) and user knowledge (pretraining/post-training tests). We collected qualitative data via focus groups with project nurses (n=12) and interviews with hospital staff (n=11). We used the quantitative data to describe the uptake of oximetry practices. We used mixed methods to explain how hospitals adopted oximetry and why it varied between contexts.
Between January 2014 and April 2017, 38 525 children (38% aged ≤28 days) were admitted to participating hospitals (23 401 pretraining; 15 124 post-training). Prior to our intervention, 3.3% of children and 2.5% of neonates had oximetry documented on admission. In the 18 months of intervention period, all hospitals improved oximetry practices, typically achieving oximetry coverage on >50% of admitted children after 2-3 months and >90% after 6-12 months. However, oximetry adoption varied in different contexts. We identified key mechanisms that influenced oximetry adoption in particular contexts.
Pulse oximetry is a simple, life-saving clinical practice, but introducing it into routine clinical practice is challenging. By exploring how oximetry was adopted in different contexts, we identified strategies to enhance institutional adoption of oximetry, which will be relevant for scale-up of oximetry in hospitals globally.
ACTRN12617000341325.
脉搏血氧饱和度测定法是一种用于识别低氧血症患儿并指导氧疗的救生工具。本研究旨在评估尼日利亚12家医院对血氧测定法的采用情况，并确定改善采用情况的策略。
我们进行了一项混合方法的现实主义评估，以了解尼日利亚12家医院如何采用血氧测定法以及为何在不同情况下存在差异。我们收集了关于血氧测定法使用情况（来自病例记录）和用户知识（培训前/培训后测试）的定量数据。我们通过与项目护士（n = 12）进行焦点小组讨论以及与医院工作人员（n = 11）进行访谈收集了定性数据。我们使用定量数据来描述血氧测定法的采用情况。我们使用混合方法来解释医院如何采用血氧测定法以及为何在不同情况下存在差异。
在2014年1月至2017年4月期间，38525名儿童（38%年龄≤28天）入住参与研究的医院（培训前23401名；培训后15124名）。在我们的干预之前，3.3%的儿童和2.5%的新生儿在入院时记录了血氧测定情况。在18个月的干预期内，所有医院都改善了血氧测定法的应用，通常在2 - 3个月后，超过50%的入院儿童实现了血氧测定覆盖，6 - 12个月后超过90%。然而，血氧测定法的采用在不同情况下存在差异。我们确定了在特定情况下影响血氧测定法采用的关键机制。
脉搏血氧饱和度测定法是一种简单的救生临床实践，但将其引入常规临床实践具有挑战性。通过探索血氧测定法在不同情况下的采用方式，我们确定了增强医院对血氧测定法机构采用的策略，这将与全球医院扩大血氧测定法的应用相关。
ACTRN12617000341325。
