Gregory Courtney
University of California San Francisco (UCSF) Benioff Children's Hospital, San Francisco, United States of America.
UCSF Centre for Evidence Synthesis & Implementation: a Joanna Briggs Institute Centre of Excellence.
JBI Database System Rev Implement Rep. 2018 Nov;16(11):2224-2245. doi: 10.11124/JBISRIR-2017-003759.
The goal of this project was to promote breastfeeding among infants with congenital heart disease in a quaternary care academic children's hospital. We aimed to increase the total number of breastfeeding episodes among all patients in the Pediatric Cardiac Transitional Care Unit with implementation of pre- and post-breastfeeding (test) weights.
Infants with congenital heart disease are able to breastfeed, but are often not encouraged to do so by healthcare providers. Fears and concerns relating to the inability to account for exact intake volumes through breastfeeding often prevent providers from supporting breastfeeding in these patients.
This project used Joanna Briggs Institute's Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit tool for promoting health practice change. A baseline medical record audit was conducted, followed by staff nurse education on breastfeeding test weights and the development of a parent education program. One follow-up audit measured compliance with best practice criteria for using breastfeeding test weights in infants with congenital heart disease.
Compliance rates for use of breastfeeding test weights and provision of parent education, with baseline rates of 7% and 0%, respectively, rose to 90%. Identification of maternal intent to breastfeed upon admission to the unit increased to 78% compliance from 0%. Eighty-four percent of healthcare staff were educated on breastfeeding test weights.
The safety of breastfeeding very ill infants was established. Breastfeeding episodes of all patients in the unit significantly increased after implementation of breastfeeding test weights and mothers of the sample patients expressed more confidence in breastfeeding their sick infants. Although barriers to breastfeeding for patients with congenital heart disease still persisted, this project had a positive impact on the culture of breastfeeding within the project unit. Increased healthcare provider education on breastfeeding will be essential to sustaining outcomes of this implementation.
本项目的目标是在一家四级医疗学术儿童医院中促进先天性心脏病患儿的母乳喂养。我们旨在通过实施母乳喂养前后（测试）体重测量，增加小儿心脏过渡护理病房所有患者的母乳喂养次数。
先天性心脏病患儿能够进行母乳喂养，但医护人员通常不鼓励他们这样做。由于担心无法准确计算母乳喂养的摄入量，医护人员往往不支持这些患者进行母乳喂养。
本项目使用乔安娜·布里格斯研究所的临床证据系统实际应用（JBI PACES）和将研究转化为实践（GRiP）审核工具来促进健康实践的改变。进行了基线病历审核，随后对护士进行了母乳喂养测试体重方面的教育，并制定了家长教育计划。一次随访审核衡量了在先天性心脏病患儿中使用母乳喂养测试体重的最佳实践标准的依从性。
使用母乳喂养测试体重和提供家长教育的依从率分别从基线时的7%和0%升至90%。入院时确定有母乳喂养意愿的母亲的依从率从0%增至78%。84%的医护人员接受了母乳喂养测试体重方面的教育。
确定了病情严重的婴儿进行母乳喂养的安全性。实施母乳喂养测试体重后，该病房所有患者的母乳喂养次数显著增加，样本患者的母亲对其患病婴儿进行母乳喂养更有信心。虽然先天性心脏病患者母乳喂养的障碍仍然存在，但本项目对项目病房内的母乳喂养文化产生了积极影响。增加医护人员对母乳喂养的教育对于维持这一实施成果至关重要。
