Telfer Michelle, Illuzzi Jessica, Jolles Diana
Yale School of Medicine, West Haven, CT
Yale School of Medicine, West Haven, CT.
J Dr Nurs Pract. 2021 May 18. doi: 10.1891/JDNP-D-20-00026.
At many hospitals, the cesarean birth rate among nulliparous term singleton vertex (NTSV) pregnancies is higher than World Health Organization benchmarks. Reducing NTSV cesarean birth is a national quality imperative. The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth.
Chart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks.
The bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%.
Implementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines.
Implementation of evidence-based bundles has the potential to achieve meaningful quality improvements in maternity care.
在许多医院，初产妇足月单胎头位（NTSV）妊娠的剖宫产率高于世界卫生组织的基准。降低NTSV剖宫产率是一项国家质量要求。该倡议的目的是在一家城市社区教学医院，在60天内至少50%的分娩中实施基于证据的综合措施，以减少产程早期入院人数，并提高对已证明可降低剖宫产率的循证产程管理指南的依从性。
通过病历审核、根本原因分析和员工参与来制定综合措施。实施了产程早期分诊指南、产程步行路径、产程图和剖宫产术前检查表以推动变革。在8周内进行了四个快速循环的计划-执行-研究-改进周期。
该综合措施在58%的分娩中得以实施。该综合措施将产程早期入院人数从41%降至25%。反映当前产程管理指南的团队知识增加了35%，因产程停滞而行剖宫产的病例中有100%符合标准。患者满意度得分超过98%。
实施基于证据的综合措施可有效减少产程早期入院人数，并提高产程管理指南的利用率和依从性。
实施基于证据的综合措施有可能在产科护理中实现有意义的质量改进。
