School of Health and Social Wellbeing, University of the West of England, Bristol, UK
School of Health and Social Wellbeing, University of the West of England, Bristol, UK.
Emerg Med J. 2022 Nov;39(11):826-832. doi: 10.1136/emermed-2021-211970. Epub 2022 Aug 1.
Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics.
A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA.
There were 1582 'normal deliveries' attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5°C. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement.
This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement.
出生前抵达医院（BBA）与不良围产结局和死亡率增加有关。BBA 后死亡的一个重要危险因素是体温过低，而紧急医疗服务（EMS）提供者非常适合提供保暖策略。然而，来自英国的研究表明，EMS 提供者（护理人员）通常不会在 BBA 后记录新生儿体温。本研究旨在确定英国西南部护理人员在处理 BBA 时记录新生儿体温的病例比例，并探讨护理人员测量体温的障碍。
采用两阶段多方法研究。第一阶段对单个英国救护服务机构在 2017 年 2 月 1 日至 2020 年 1 月 31 日期间的电子患者护理记录中的匿名数据进行分析，以确定 1）护理人员出勤的频率和 2）这些分娩中记录新生儿体温的百分比，以及体温过低的比例。第二阶段对来自同一救护服务机构的 20 名在职护理人员进行了访谈，以探讨他们在 BBA 后测量和管理新生儿体温的经验，以及面临的障碍和促进因素。
在研究期间，有 1582 名“正常分娩”由护理人员护理。在 1582 例中，有 43/1582 例（2.7%）记录了新生儿体温，其中 72%低于 36.5°C。访谈数据表明，护理人员测量新生儿体温存在一些障碍和潜在的促进因素。障碍包括设备不可用或不合适、优先考虑其他护理活动、缺乏分娩经验以及对职责和角色的不确定性。可能的促进因素包括更好的设备、身体提示以及有关测量体温重要性的培训和提高认识。
本研究表明，英国西南部在 BBA 后护理人员缺乏对新生儿体温的测量，并强调了可以作为改善新生儿体温测量干预措施基础的障碍和促进因素。
