Neonatology, Kalawati Saran Children's Hospital, New Delhi, India.
Neonatology, Kalawati Saran Children's Hospital, New Delhi, India
BMJ Open Qual. 2021 Jul;10(Suppl 1). doi: 10.1136/bmjoq-2021-001353.
Late-onset neonatal sepsis (LONS) is a significant contributor to morbidity and mortality in very low birthweight (VLBW) neonates with indwelling central lines. Compliance to central line care bundles is suboptimal in low-and-middle-income country settings. Point of care quality improvement (POCQI) method may be used to improve the compliance gap. We used the POCQI method to achieve an improvement in compliance to central line care bundles with an aim to reduce LONS in a subset of VLBW neonates.
A pre and post-intervention study consisting of three phases was conducted in a tertiary care neonatal intensive care unit. A root-cause analysis was undertaken to find the causes of LONS in VLBW babies with central lines. Multiple change ideas were identified and tested using sequential Plan-Do-Study-Act (PDSA) cycles to address the issue of reduced compliance to the central line care bundles. The change ideas tested in PDSA cycles which were successful were adopted. Compliance to the insertion and maintenance bundles was measured as process indicators. LONS, central line associated bloodstream infections and all-cause mortality rates were measured as outcome indicators.
A total of 10 PDSA cycles testing multiple change ideas (staff education, audio-visual aids, supply issues) were undertaken during the study duration. Bundles were not being used in the study setting prior to the initiation of the study. Insertion bundle compliance was above 90% and maintenance bundle compliance increased from 23.3% to 42.2% during the intervention and sustenance phases, respectively. A 43.3% statistically significant reduction in LONS rates was achieved at the end of the study. No effect on mortality was seen.
POCQI method can be used to improve compliance to central line care bundles which can lead to a reduction of LONS in VLBW neonates with central lines in situ.
迟发型新生儿败血症（LONS）是极低出生体重（VLBW）新生儿留置中心静脉导管发病率和死亡率的重要原因。在中低收入国家，中心静脉导管护理包的依从性并不理想。即时护理质量改进（POCQI）方法可用于缩小依从性差距。我们使用 POCQI 方法来提高中心静脉导管护理包的依从性，旨在减少特定 VLBW 新生儿的 LONS。
在一家三级新生儿重症监护病房进行了一项包括三个阶段的干预前和干预后研究。进行了根本原因分析，以确定带中央静脉导管的 VLBW 婴儿发生 LONS 的原因。确定了多个变更思路，并使用连续的计划-执行-研究-行动（PDSA）循环进行测试，以解决减少对中央静脉导管护理包的依从性的问题。在 PDSA 循环中测试的成功变更思路被采用。插入和维护包的依从性作为过程指标进行测量。LONS、与中心静脉导管相关的血流感染和全因死亡率作为结果指标进行测量。
在研究期间共进行了 10 次 PDSA 循环测试，以测试多种变更思路（员工教育、视听辅助、供应问题）。在研究开始之前，研究环境中未使用护理包。插入包的依从性高于 90%，而维护包的依从性在干预和维持阶段分别从 23.3%增加到 42.2%。在研究结束时，LONS 发生率显著降低了 43.3%。未观察到死亡率的变化。
POCQI 方法可用于提高中心静脉导管护理包的依从性，从而减少带中央静脉导管的 VLBW 新生儿的 LONS。
