Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK.
Neonatal Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
Arch Dis Child Fetal Neonatal Ed. 2020 Nov;105(6):652-655. doi: 10.1136/archdischild-2019-318636. Epub 2020 Apr 29.
To increase the documented use of the Lifestart trolley to allow premature infants' (<32 weeks' gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.
A 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.
Documented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).
By undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.
增加使用 Lifestart 轮床的记录，以便在分娩时对早产儿（<32 周妊娠）进行复苏和稳定，同时保持脐带完整。
2018 年 4 月至 2019 年 4 月进行了为期 13 个月的质量改进计划，使用计划、执行、研究和行动（PDSA）循环。回顾了 113 例连续的早产儿（<32 周）分娩的数据，以确定是否使用了 Lifestart，以及是否按照医院政策对符合条件的婴儿进行了 2 分钟延迟脐带夹闭（DCC）。分析了不遵守规定的情况，确定了原因，并实施了干预措施，以减少类似的未来不遵守规定的情况。收集的数据以图形形式呈现，并包含在每月交替的员工通讯中，其中还包括从不遵守规定的审查中吸取的教训。
Lifestart 的记录使用率从项目开始时的 10%上升到最后一个月的 79%。并非所有婴儿都有资格进行 DCC。在这个项目中，有 40 名（35%）早产儿不符合接受 DCC 的条件。在符合条件的婴儿中，DCC 的比例从项目前 3 个月的 17%增加到最后 3 个月的 92%（p<0.0001）。
通过定期进行 PDSA 循环并改善对 DCC 重要性的教育，我们注意到 Lifestart 的使用显著增加，这反过来又促进了 DCC 的实施。从这个项目中吸取的经验教训已被用于创建一个教学视频，以帮助维持改进的合规率。
