手术婴儿皮肤接触的安全性和可行性：一项质量改进项目。

Safety and feasibility of skin-to-skin care for surgical infants: A quality improvement project.

机构信息

Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California.

Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH.

出版信息

J Pediatr Surg. 2019 Nov;54(11):2428-2434. doi: 10.1016/j.jpedsurg.2019.02.016. Epub 2019 Feb 28.

DOI:10.1016/j.jpedsurg.2019.02.016

PMID:30879741

Abstract

BACKGROUND

Skin-to-skin care (SSC) for infants improves physiologic stability, pain perception, brain development, parental bonding, and overall survival. Using quality improvement (QI) methodology, this project aimed to increase SSC for surgical infants in the neonatal intensive care unit (NICU).

METHODS

A multidisciplinary working group composed of key NICU stakeholders instituted a needs assessment querying perceptions and concerns about SSC. Based on survey results, multiple system level interventions were implemented. Data for surgical infants receiving SSC during hospitalization were tracked over time using the electronic health record.

RESULTS

Overall, 315 infants requiring a surgical consult were admitted to the NICU in the first 12 months of the project. After six months, SSC rates in this group increased from 51% to 60.5% (p < 0.01) and were sustained for 12 months. After one year, nursing staff reporting that they were somewhat to very comfortable providing SSC for surgical infants increased from 44% to 75% (p = 0.001) and the percent of nurses providing SSC for a surgical infant increased from 12% to 37% (p = 0.001). Inadvertent extubation did not significantly increase after implementation of the QI project.

CONCLUSIONS

Using QI methodology and multidisciplinary engagement, SSC was integrated safely into the routine care of surgical infants in the NICU.

LEVEL OF EVIDENCE

Level V.

摘要

背景

皮肤接触护理（SSC）可改善婴儿的生理稳定性、疼痛感知、大脑发育、亲子关系和整体存活率。本项目采用质量改进（QI）方法，旨在提高新生儿重症监护病房（NICU）中外科婴儿的 SSC 使用率。

方法

一个由 NICU 主要利益相关者组成的多学科工作组进行了一项需求评估，询问他们对 SSC 的看法和担忧。根据调查结果，实施了多项系统层面的干预措施。通过电子健康记录，跟踪了在院期间接受 SSC 的外科婴儿的数据。

结果

在项目实施的前 12 个月，共有 315 名需要外科会诊的婴儿被收入 NICU。6 个月后，该组婴儿的 SSC 使用率从 51%增加到 60.5%（p<0.01），并持续了 12 个月。一年后，报告称他们对为外科婴儿提供 SSC 感到有些舒适到非常舒适的护理人员比例从 44%增加到 75%（p=0.001），为外科婴儿提供 SSC 的护士比例从 12%增加到 37%（p=0.001）。实施 QI 项目后，无意拔管并未显著增加。