产科肛门括约肌损伤护理包：一项质量改进举措。
Obstetric Anal Sphincter Injury Care Bundle: A Quality Improvement Initiative.
作者信息
Powell T Clark, Hoke Tanya P, Norris Kyle P, Page Margaret R, Todd Allison, Redden David T, Brumfield Cynthia G, Straughn J Michael, Richter Holly E
机构信息
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6Th Ave S, 176F Suite 10382, Birmingham, AL, 35233, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Int Urogynecol J. 2024 Nov;35(11):2125-2130. doi: 10.1007/s00192-024-05885-2. Epub 2024 Sep 27.
INTRODUCTION AND HYPOTHESIS
The objective was to implement an evidence-based peri-partum care bundle for women sustaining obstetric anal sphincter injuries and to evaluate compliance with recommendations for antibiotics use, repair in the operating room, and follow-up before and after implementation.
METHODS
This project was reviewed by the Institutional Review Board and determined to be exempt. A clinical care bundle containing education and standardized orders in the electronic medical record was implemented. Characteristics of pre- (October 2017 to September 2019) and post-intervention (October 2019 to August 2021) cohorts were compared and compliance with recommendations for antibiotics use, surgical repair location, and follow-up were evaluated. Chi-squared, Fisher's exact, ANOVA F, and Kruskal-Wallis tests were performed, as indicated. Significance level was p < 0.05.
RESULTS
A total of 185 cases were identified. Seventy-five percent of women were nulliparous. Mean gestational age was 39 weeks. Pre- and post-intervention groups did not differ in age, BMI, race, parity, gestational age, comorbidities, birthweight, or delivery type. Ninety-eight cases were identified pre-implementation. Eighty-six (88%) had third-degree lacerations. Post-implementation, 87 cases were identified. Seventy (80%) had third-degree lacerations (p = 0.17). Recommended antibiotic-type use improved from 35% pre-implementation to 93% post-implementation (p < 0.001). Repair in the operating room was similar pre-implementation and post-implementation (16.0% vs 12.6%, p = 0.48). Post-partum follow-up within 2 weeks improved from 16.3% pre-implementation to 52.8% post-implementation and mean time to follow-up was shorter post-implementation than pre-implementation (18 vs 33 days; both p < 0.001).
CONCLUSIONS
Implementation of an evidence-based peri-partum care bundle resulted in standardization of care in accordance with established recommendations. Compliance with recommendations for surgical repair in the operating room remained unchanged.
引言与假设
目的是为遭受产科肛门括约肌损伤的女性实施基于证据的围产期护理包，并评估实施前后抗生素使用、手术室修复及随访建议的依从性。
方法
本项目经机构审查委员会审查，确定为豁免项目。实施了一个包含电子病历中的教育内容和标准化医嘱的临床护理包。比较了干预前（2017年10月至2019年9月）和干预后（2019年10月至2021年8月）队列的特征，并评估了抗生素使用、手术修复位置及随访建议的依从性。根据需要进行了卡方检验、Fisher精确检验、方差分析F检验和Kruskal-Wallis检验。显著性水平为p < 0.05。
结果
共识别出185例病例。75%的女性为初产妇。平均孕周为39周。干预前和干预后组在年龄、体重指数、种族、产次、孕周、合并症、出生体重或分娩类型方面无差异。实施前识别出98例病例。其中86例（88%）为三度裂伤。实施后，识别出87例病例。其中70例（80%）为三度裂伤（p = 0.17）。推荐抗生素类型的使用从实施前的35%提高到实施后的93%（p < 0.001）。实施前和实施后在手术室进行修复的情况相似（16.0%对12.6%，p = 0.48）。产后2周内的随访从实施前的16.3%提高到实施后的52.8%，且实施后的平均随访时间比实施前短（18天对33天；两者p < 0.001）。
结论
实施基于证据的围产期护理包导致护理按照既定建议实现标准化。手术室手术修复建议的依从性保持不变。
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