Shakeel Fauzia M, Crews Jacquelyn, Jensen Preceous, Ritchey Andrea, Allen Megan, Mateus Jazmine, Machry Joana
Department of Neonatology, Maternal Fetal and Neonatal Institute; Johns Hopkins All Children's Hospital St. Petersburg, Fla.
Department of Pediatrics. Johns Hopkins All Children's Hospital, St. Petersburg, Fla.
Pediatr Qual Saf. 2021 Mar 10;6(2):e394. doi: 10.1097/pq9.0000000000000394. eCollection 2021 Mar-Apr.
Gastroesophageal reflux (GER) is a functional self-limiting condition in neonates. When pathologic, it is called GER disease (GERD). There are wide variations in the management of signs, symptoms, and complications associated with GERD in the neonatal intensive care unit (NICU). Evidence does not support an empiric trial of GERD medications as a diagnostic tool or therapy in premature infants.
A multidisciplinary team developed evidence-based clinical practice guidelines (CPG) for GERD management. Process improvement included developing a GERD management algorithm, electronic order sets, and education for all providers. Multiple plan-do-study-act cycles done.
Implementation of standardized GERD management guideline, decreased the overall use of antireflux medications from baseline, 15.1%-6.8% [χ (1, N = 1259) = 12.98, < 0.001]. There was elimination of GERD medication use in preterm from baseline of 19.3% [χ (1, N = 220) = 12.18, < 0.001]. The most frequently used GERD medication was lansoprazole, with an incorrect initial dosing rate of 55.0% that deceased to zero [χ (1, N = 33) = 10.73, = 0.001]. Appropriate testing with PH probe with 24-hour multichannel impedance was observed (17.1%-28.0%) identifying patients with correct GERD diagnosis [χ (1, N = 101) = 1.41, = 0.236]. Length of stay for GERD patient's improved from a median of 89-53 days.
Standardizing clinical management leads to best practices for GERD management with appropriate diagnostic testing, eliminating incorrect medication dosing, and improved patient safety with value-based outcomes.
胃食管反流（GER）在新生儿中是一种功能性自限性病症。当出现病理性情况时，称为胃食管反流病（GERD）。在新生儿重症监护病房（NICU）中，与GERD相关的体征、症状及并发症的管理存在很大差异。证据不支持将GERD药物的经验性试验作为早产儿的诊断工具或治疗方法。
一个多学科团队制定了基于证据的GERD管理临床实践指南（CPG）。流程改进包括制定GERD管理算法、电子医嘱集，并对所有医护人员进行培训。进行了多个计划-执行-研究-行动循环。
实施标准化的GERD管理指南后，抗反流药物的总体使用量较基线水平有所下降，从15.1%降至6.8%[χ(1, N = 1259) = 12.98, P < 0.001]。早产儿中GERD药物的使用从基线水平的19.3%降至零[χ(1, N = 220) = 12.18, P < 0.001]。最常用的GERD药物是兰索拉唑，初始给药错误率为55.0%，后降至零[χ(1, N = 33) = 10.73, P = 0.001]。观察到使用24小时多通道阻抗pH探头进行适当检测的比例（从17.1%升至28.0%），从而正确诊断GERD患者[χ(1, N = 101) = 1.41, P = 0.236]。GERD患者的住院时间从中位数89天缩短至53天。
标准化临床管理可实现GERD管理的最佳实践，包括进行适当的诊断检测、消除错误的药物剂量，并通过基于价值的结果提高患者安全性。
