J Obstet Gynecol Neonatal Nurs. 2021 Mar;50(2):193-204. doi: 10.1016/j.jogn.2020.10.008. Epub 2021 Jan 17.
To measure the increase in rates of skin-to-skin contact (SSC) for at least 15 minutes within the first hour of life in the operating room (OR) after cesarean birth after implementation of an SSC initiative. Our goal was to improve the rate of SSC from 20.3% to 50% for eligible newborns.
Quality improvement initiative with a pre-post-practice implementation design using surveys.
SETTING/LOCAL PROBLEM: A tertiary academic hospital in the U.S. Midwest with more than 12,500 births annually.
Nursing staff on a labor and delivery unit (N = 40).
INTERVENTIONS/MEASUREMENTS: We implemented nurse education, included SSC as part of the interdisciplinary team time-out (TTO) before procedures, and developed a new practice guideline to initiate SSC for at least 15 minutes within the first hour of life in the OR after cesarean birth. We measured nurses' knowledge and self-reported SSC practices with preimplementation and postimplementation surveys. We measured nurses' inclusion of SSC in the TTO and actual SSC practices in the OR with an audit tool.
We analyzed a total of 394 audit tool forms from the initiative. Nurses reported more use of SSC after implementation of the SSC initiative. Skin-to-skin contact was verbalized in 75.3% (70/93) of the TTOs after implementation, and SSC for 15 minutes in the OR was completed in 20.3% (16/79) of preimplementation and 24.7% (23/93) of postimplementation phases. Total SSC for any length of time within the first hour in the OR increased from 30.4% (24/79) to 61.3% (57/93) in eligible women and newborns after implementation of the initiative.
SSC in the OR increased after a 4-month initiative to increase SSC through nurse education, inclusion of SSC in the TTO, and a new guideline to initiate SSC in the OR at least 15 minutes within the first hour of life.
在剖宫产术后手术室（OR）中，实施皮肤接触（SSC）举措后，测量头 1 小时内 SSC 持续时间至少 15 分钟的比例增加情况。我们的目标是将符合条件的新生儿的 SSC 比例从 20.3%提高到 50%。
采用预前后实践实施设计的质量改进举措，使用调查进行研究。
地点/问题背景：美国中西部的一家三级学术医院，每年有超过 12500 例分娩。
产房的护理人员（N=40）。
干预措施/测量方法：我们实施了护士教育，在进行程序前的跨学科团队暂停（TTO）中包含 SSC，并制定了新的实践指南，要求在剖宫产术后手术室中，头 1 小时内至少进行 15 分钟的 SSC。我们使用预实施和实施后调查来测量护士的知识和自我报告的 SSC 实践情况。我们使用审核工具来测量护士在 TTO 中纳入 SSC 以及在 OR 中实际进行 SSC 的情况。
我们分析了该举措的共 394 份审核工具表格。护士报告在实施 SSC 举措后更频繁地使用 SSC。实施后，75.3%（70/93）的 TTO 中口头提到了 SSC，在 OR 中完成了 15 分钟的 SSC，而在实施前的 20.3%（16/79）和实施后的 24.7%（23/93）阶段。在实施该举措后，符合条件的女性和新生儿在 OR 中头 1 小时内的任何时长的 SSC 总比例从 30.4%（24/79）增加到 61.3%（57/93）。
通过护士教育、在 TTO 中纳入 SSC 以及在 OR 中启动 SSC 至少 15 分钟的新指南，实施了为期 4 个月的增加 SSC 的举措后，OR 中的 SSC 增加了。
