Snyder Gail, Wilkinson Rebekah, Evans Raina, Owen Meagan, Yazdani Akram, Tibe Covi, Perez Catherine, Holzapfel Lindsay F
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Children's Memorial Hermann Hospital, Neonatal Intensive Care Unit, Houston, TX, USA.
J Perinatol. 2025 May;45(5):680-685. doi: 10.1038/s41372-025-02327-9. Epub 2025 Jun 2.
Accurate length measurements are essential for infants to identify growth deficiencies and adjust nutrition accordingly. The gold standard for length measurement in infants is using a length board with two people to obtain an accurate clinical assessment. We aimed to improve the number of measurements with the desired minimal difference, defined as a discrepancy ≤1 cm between nurse and audit measurements, in our center. Our secondary aim was to increase and maintain the number of length boards available.
This quality improvement (QI) study used a before-and-after intervention comparison design in a single-level IV neonatal intensive care unit between June 2023 and December 2023, completing two Plan-Do-Study-Act (PDSA) cycles and one sustainability cycle that targeted nursing interventions. Blinded audits were performed by the QI team < 48 h after bedside nurse measurement and discrepancies between measurements were recorded. Chi-squared testing determined the significance between measurement discrepancies at each time point.
The QI team measured 34 infants at each time point for 136 total measurements. There was a significant improvement in the desired minimal difference between the pre-intervention and post-PDSA #2 groups (38% vs 74%, p = 0.003) and between the pre-intervention and sustainability cycle groups (38% vs 71%, p = 0.007). There was no significant difference between PDSA #2 and our sustainability cycle. There was a 32% improvement among infants with consistent length percentiles between nurse and audit measures after PDSA #2 (42% vs 74%, p = 0.012). The number of length boards was increased during the study. Anonymous nursing surveys revealed an improvement in the perceived ease of use of length boards (51-71%) and minimized knowledge gaps.
During the time of our intervention, there was an improvement in the precision of linear measurements and length board usage. Future PDSA cycles will focus on increasing the availability of length boards and establishing continued length board education.
准确的身长测量对于识别婴儿生长缺陷并据此调整营养至关重要。婴儿身长测量的金标准是由两人使用身长板以获得准确的临床评估。我们旨在提高本中心测量结果达到所需最小差异（定义为护士测量值与审核测量值之间的差异≤1厘米）的测量次数。我们的次要目标是增加并维持可用身长板的数量。
这项质量改进（QI）研究在2023年6月至2023年12月期间，于一家一级IV新生儿重症监护病房采用干预前后比较设计，完成了两个计划-实施-研究-改进（PDSA）循环和一个针对护理干预的可持续性循环。QI团队在床边护士测量后<48小时进行盲法审核，并记录测量值之间的差异。卡方检验确定每个时间点测量差异之间的显著性。
QI团队在每个时间点测量了34名婴儿，共进行了136次测量。干预前与PDSA #2组后（38%对74%，p = 0.003）以及干预前与可持续性循环组之间（38%对71%，p = 0.007），所需最小差异有显著改善。PDSA #2与我们的可持续性循环之间无显著差异。PDSA #2后，护士与审核测量的身长百分位数一致的婴儿中有32%得到改善（42%对74%，p = 0.012）。研究期间身长板数量增加。匿名护理调查显示，身长板的易用性感知有所改善（51 - 71%），知识差距最小化。
在我们的干预期间，线性测量的精度和身长板的使用有所改善。未来的PDSA循环将专注于增加身长板的可用性并开展持续的身长板教育。
