剖宫产术中实现母婴早期皮肤接触：一项质量改进举措。

Achieving Early Mother-baby Skin-to-skin Contact in Caesarean Section: A Quality Improvement Initiative.

作者信息

Maria Arti, Shukla Amlin, Wadhwa Rashmi, Kaur Bhupinder, Sarkar Bani, Kaur Mohandeep

机构信息

Department of Neonatology, Postgraduate Institute of Medical Education and Research and Dr RML Hospital, New Delhi, India.

Department of Neonatology, Postgraduate Institute of Medical Education and Research and Dr RML Hospital, New Delhi, India. Correspondence to: Dr Amlin Shukla, Assistant Professor, Department of Neonatology, Postgraduate Institute of Medical Education and Research and Dr RML Hospital, New Delhi 110 001, India.

出版信息

Indian Pediatr. 2018 Sep 15;55(9):765-767.

PMID:30345981

Abstract

OBJECTIVE

To improve rate of skin-to-skin contact for early initiation of breastfeeding at birth on operation table among healthy term and late pretem babies born by caesarean sections from 0% to 80% in eight weeks.

METHODS

A quality improvement initiative was undertaken at maternity-newborn care unit of a tertiary-care hospital. A team involving Neonatologists/Pediatricians, Obstetricians, Anaesthesiologists, and Nurses in concerned areas identified problem areas using Fish bone analysis. Situational analysis was done through process flow mapping. Three Plan-do-study-act cyles were undertaken. Firstly, sensitization of personnel was done and a written policy was made. Secondly, maternal counselling and procedural modifications were done. Lastly, efforts were made to improve duration of contact.

RESULTS

Rate of early skin-to-skin contact after Plan-do-study-act cycle 1, 2 and 3, respectively was 87.5%, 90% and 83.3%. It was 100% after sustainability phase after four months.

CONCLUSION

Early skin-to-skin contact was achievable through sensitization of all persons involved and simple procedural changes. Prolonging duration of contact remained a challenge.

摘要

目的

将剖宫产出生的足月健康婴儿和晚期早产儿在手术台上出生后早期进行母乳喂养时的皮肤接触率在八周内从0%提高到80%。

方法

在一家三级医院的母婴护理单元开展了一项质量改进举措。一个由新生儿科医生/儿科医生、产科医生、麻醉师和相关领域护士组成的团队使用鱼骨分析法确定问题区域。通过流程映射进行情况分析。进行了三个计划-执行-研究-行动周期。首先，对人员进行了培训并制定了书面政策。其次，对产妇进行了咨询并对程序进行了修改。最后，努力延长接触时间。