一项旨在减少早产代谢性骨病继发骨折的质量改进项目。
A Quality Improvement Project to Decrease Fractures Secondary to Metabolic Bone Disease of Prematurity.
作者信息
Rau Nicole M, Monagle Lisa J, Fischer Ashley M
机构信息
From the Division of Neonatology, Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Ill.
Department of Foods and Nutrition, OSF St Francis Medical Center, Peoria, Ill.
出版信息
Pediatr Qual Saf. 2024 Jul 29;9(4):e750. doi: 10.1097/pq9.0000000000000750. eCollection 2024 Jul-Aug.
INTRODUCTION
Osteopenia of prematurity is common in the neonatal intensive care unit, with an incidence of up to 54% in extremely low birthweight infants. The baseline fracture rate in our level IV midwestern neonatal intensive care unit was 13%, with poor compliance with recommended intakes of calcium, calcium:phosphorus ratio, and Vitamin D.
METHODS
A multidisciplinary team implemented a screening guideline through four Plan-Do-Study-Act cycles, which addressed staff education, vitamin D screening, and incorporation of calcitriol. In total, 150 patients born between October 1, 2019 and April 30, 2023 were screened for mineral intakes, laboratory abnormalities, and the development of fractures or osteopenia.
RESULTS
The incidence of fractures decreased from 13% to 5.3%. Compliance with mineral intakes improved for calcium, calcium: phosphorus ratio, and Vitamin D. Infants born after the guideline were 4.8 times less likely to develop fractures.
CONCLUSION
Quality improvement methodology successfully decreased the rate of fractures due to osteopenia of prematurity and increased compliance with recommended mineral intakes.
引言
早产骨质减少在新生儿重症监护病房很常见，极低出生体重儿的发病率高达54%。在我们位于中西部的四级新生儿重症监护病房，基线骨折率为13%，对推荐的钙摄入量、钙磷比和维生素D的依从性较差。
方法
一个多学科团队通过四个计划-执行-研究-改进循环实施了一项筛查指南，该指南涉及工作人员教育、维生素D筛查和骨化三醇的应用。总共对2019年10月1日至2023年4月30日期间出生的150名患者进行了矿物质摄入、实验室异常以及骨折或骨质减少发展情况的筛查。
结果
骨折发生率从13%降至5.3%。钙、钙磷比和维生素D的矿物质摄入依从性有所改善。指南实施后出生的婴儿发生骨折的可能性降低了4.8倍。
结论
质量改进方法成功降低了早产骨质减少导致的骨折发生率，并提高了对推荐矿物质摄入的依从性。
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