袋鼠式护理在三级教学医院病房的利用：一项质量改进研究。

Kangaroo mother care utilization at stepdown ward of a tertiary care teaching hospital: a quality improvement study.

机构信息

Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325, India.

Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, 388325, India.

出版信息

J Trop Pediatr. 2023 Oct 5;69(6). doi: 10.1093/tropej/fmad041.

DOI:10.1093/tropej/fmad041

PMID:38006294

Abstract

PURPOSE

India has the highest burden of preterm/low birth weight newborns. To tackle this, Kangaroo Mother Care (KMC) needs to be scaled up. We did a quality improvement (QI) study to increase KMC coverage to 80% and its utilization to at least 4 h/infant/day.

METHODS

This study was conducted at a stepdown ward (KMC ward) of a tertiary care teaching institute over a period of four months. All babies with birth weight <2.5 kg were eligible. The QI team included faculty in-charge, one senior resident and three senior staff nurses. Potential barriers were listed using fish-bone analysis. Four possible interventions were identified (daily documentation of total KMC hours by doctor, providing KMC during all the nursing duty shifts, counseling and education to mothers and family members), introduced, and then subsequently tested by four Plan-Do-Study-Act (PDSA) cycles and sustenance was assessed over three months.

RESULTS

A total of 93 infants were included in this QI study. During baseline phase, the KMC coverage was 50% which increased to 100% by the end of fourth PDSA cycle and remained 100% during the sustenance phase. During baseline period, KMC was given for ≥ 4 h in 18.8% (28 of 149) patient days which increased to 88.96% (137 of 154) during the sustenance phase. The mean KMC utilization increased from 1.97 (1.57) h/infant/day to 5.65 (1.20) h/infant/day in the sustenance phase.

CONCLUSION

QI study incorporating PDSA cycles helped improve coverage and utilization of KMC.

摘要

目的

印度早产儿/低出生体重儿负担最重。为了解决这个问题，需要扩大袋鼠式护理（KMC）的规模。我们进行了一项质量改进（QI）研究，以将 KMC 覆盖率提高到 80%，并将其利用率提高到至少 4 小时/婴儿/天。

方法

这项研究在一家三级保健教学机构的降阶病房（KMC 病房）进行，历时四个月。所有出生体重<2.5kg 的婴儿都有资格参加。QI 团队包括主管教员、一名高级住院医师和三名高级护士长。使用鱼骨图分析列出了潜在的障碍。确定了四项可能的干预措施（医生每天记录 KMC 总时间、在所有护理班次提供 KMC、对母亲和家庭成员进行咨询和教育），并通过四个计划-执行-研究-行动（PDSA）循环进行了介绍和测试，然后在三个月内进行了维持评估。

结果

这项 QI 研究共纳入 93 名婴儿。在基线阶段，KMC 覆盖率为 50%，在第四个 PDSA 循环结束时增加到 100%，在维持阶段保持 100%。在基线期间，在 149 个患者日中有 18.8%（28 个）的 KMC 时间≥4 小时，在维持阶段增加到 154 个患者日中的 88.96%（137 个）。在维持阶段，KMC 利用率从 1.97（1.57）小时/婴儿/天增加到 5.65（1.20）小时/婴儿/天。