儿科重症监护病房中持续[此处原文不完整，推测可能是某种情况或措施]的跨专业方法。
Interprofessional Approach to the Sustained in a Pediatric Intensive Care Unit.
作者信息
McBeth Cheryl Lynne, Montes Rosa Solis, Powne Amy, North Sopon Elizabeth, Natale JoAnne E
机构信息
Cheryl Lynne McBeth is a nurse manager for the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), and Critical Care Transport Team, University of California, Davis, Children's Hospital, Sacramento, California. Rosa Solis Montes is clinical nurse III, University of California, Davis, Children's Hospital. She has been the cochair or chair of the No VAP committee since 2010. Amy Powne is Fetal Care and Treatment Center registered nurse coordinator at University of California, Davis, Children's Hospital. Sopon Elizabeth North is clinical nurse III, University of California, Davis, Children's Hospital. She currently is chair of the PICU/PCICU Hospital-Acquired Infection Committee. JoAnne E. Natale is professor of clinical pediatrics, Pediatric Critical Care, Children's Hospital Quality & Safety, and director of quality and safety, University of California, Davis, Medical Center.
出版信息
Crit Care Nurse. 2018 Dec;38(6):36-45. doi: 10.4037/ccn2018121.
BACKGROUND
Ventilator-associated pneumonia (VAP) increases morbidity, mortality, and health care costs.
OBJECTIVE
To reduce the VAP rate in the pediatric/cardiac intensive care unit to fewer than 2 events per 1000 ventilator days within 2 years and to sustain a rate near 0 for the next 5 years.
METHODS
An evidence-based VAP prevention bundle was developed and implemented by an interprofessional team using the Six Sigma Define, Measure, Analyze, Improve, Control methodology. The mixed unit's 5-element VAP prevention bundle consisted of age-appropriate oral care, proper airway suction technique, maintenance of safe endotracheal-tube cuff pressures, aspiration precautions, and head-of-bed elevation. Knowledge and practice were reinforced through multidisciplinary education and one-on-one teaching. Practice compliance was monitored through regular, unannounced bedside audits linked to just-in-time teaching.
RESULTS
Within 2 years, the annual VAP rate fell from 7.86 to 1.16 events per 1000 ventilator days; VAP bundle-element compliance ranged from 86% to 99%. There were no VAP events during a 10-quarter period in 2012 through 2014.
CONCLUSIONS
Development, implementation, and revision of a VAP prevention strategy using the Define, Measure, Analyze, Improve, Control methodology was associated with marked, sustained reduction in VAP rates, notably during the unit's expansion from 16 to 24 beds, the opening of a pediatric cardiothoracic unit, and the hiring of more than 80 new nurses. After 7 years, the VAP rate continues to be low at 0.86 for 2016 and 0 through June 2017.
背景
呼吸机相关性肺炎（VAP）会增加发病率、死亡率及医疗费用。
目的
在两年内将儿科/心脏重症监护病房的VAP发生率降至每1000个呼吸机日少于2例，并在接下来的五年内维持接近0的发生率。
方法
一个跨专业团队采用六西格玛定义、测量、分析、改进、控制方法制定并实施了基于证据的VAP预防综合措施。该混合病房的五项VAP预防综合措施包括适合年龄的口腔护理、正确的气道吸引技术、维持安全的气管内导管套囊压力、误吸预防措施以及床头抬高。通过多学科教育和一对一教学强化知识与实践。通过与即时教学相关的定期、突击床边审核来监测实践依从性。
结果
两年内，每年的VAP发生率从每1000个呼吸机日7.86例降至1.16例；VAP综合措施要素的依从率在86%至99%之间。在2012年至2014年的10个季度期间未发生VAP事件。
结论
采用定义、测量、分析、改进、控制方法制定、实施和修订VAP预防策略与VAP发生率显著、持续降低相关，尤其是在病房从16张床位扩展到24张床位、开设儿科心胸外科病房以及招聘80多名新护士期间。七年后，2016年的VAP发生率持续低至0.86，截至2017年6月为0。
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