Peterson Jennifer, Ranganna Ranganath
NICU, St Mary's Maternity Hospital, Manchester Foundation Trust, Manchester, United Kingdom.
Hosp Pediatr. 2023 Mar 1;13(3):265-273. doi: 10.1542/hpeds.2022-006681.
The aim of this quality improvement (QI) project was to increase deferred cord clamping (DCC) rates in preterm infants (≤36 + 6 weeks) to 50% of eligible infants over an 18-month period.
The multidisciplinary neonatal quality improvement team collaboratively developed a driver diagram to address the key issues and tasks to launching DCC. Serial plan-do-study-act cycles were used to implement successive changes and integrate DCC as normal practice. Statistical process control charts were used to track and share project progress.
This QI project has increased rates of deferred cord clamping for preterm infants from zero to 45%. Our DCC rates have sequentially increased with each plan-do-study-act cycle and have shown sustained increases without significant compromise in other aspects of neonatal care, such as thermoregulation.
DCC is a core element of good quality perinatal care. This QI project encountered several limiting factors to progress, including resistance to change from clinical staff and the impact on staffing and education secondary to the coronavirus disease 2019 pandemic. Our QI team used a range of approaches, such as virtual education strategies and narrative storytelling to overcome these obstacles to QI progress.
本质量改进（QI）项目的目的是在18个月的时间内，将早产儿（≤36 + 6周）的延迟脐带结扎（DCC）率提高到符合条件婴儿的50%。
多学科新生儿质量改进团队共同制定了一个驱动图，以解决开展DCC的关键问题和任务。采用连续的计划-执行-研究-行动循环来实施连续的变革，并将DCC纳入常规实践。使用统计过程控制图来跟踪和分享项目进展。
该QI项目已将早产儿的延迟脐带结扎率从零提高到45%。我们的DCC率在每个计划-执行-研究-行动循环中都依次提高，并且在新生儿护理的其他方面，如体温调节，没有受到显著影响的情况下持续上升。
DCC是优质围产期护理的核心要素。该QI项目在推进过程中遇到了几个限制因素，包括临床工作人员对变革的抵制以及2019年冠状病毒病大流行对人员配备和教育的影响。我们的QI团队采用了一系列方法，如虚拟教育策略和叙事式讲述，以克服这些阻碍QI进展的障碍。
