Floyd A M
Pediatric and Neonatal Service, White Memorial Medical Center, Los Angeles 90033-2462, USA.
Jt Comm J Qual Improv. 1997 Feb;23(2):93-101. doi: 10.1016/s1070-3241(16)30302-9.
In 1992 the 29-bed, Level III neonatal intensive care unit (NICU) at White Memorial Medical Center in Los Angeles discovered that nursing care strategies designed to support the normal development of premature infants, as suggested by research findings, were often inconsistent with existing policies, protocols, and physician preferences.
STARTING THE INFANT STRESS REDUCTION QUALITY IMPROVEMENT (QI) TEAM: In 1993 a QI team set out to recommend changes in patient care which would reduce newborns' stress in the NICU. Given the complexity of neonatal care and the diversity of team members' professional training, the hospital contracted with a psychologist to present a two-day NICU training program that emphasized the application of current research findings regarding the physiologic and developmental effects (that is, complications) of stressors on infants.
Changes in care required negotiations with the physicians and directors of affected departments, extensive rewriting of policies, clinical evaluations, requests of additional supplies, and comprehensive staff training. Changes were made in the NICU environment (for example, light and noise reductions), NICU admission process (for example, placing of umbilical arterial lines, flexed positioning of infant extremities, thermal stress), developmental care (for example, the infant's need for soothing, ability for social interaction), and suctioning procedures (for example, suctioning and lavaging only when the infant is symptomatic rather than on a preset schedule, keeping the infant's head midline instead of turning it from side to side).
Improvement in a six-month period following implementation of the team's recommendations were identified, supporting the initial hypothesis that redesigning procedures and care protocols could reduce the stress of the patients in the NICU.
1992年，洛杉矶怀特纪念医疗中心拥有29张床位的三级新生儿重症监护病房（NICU）发现，研究结果所建议的旨在支持早产儿正常发育的护理策略，往往与现有政策、规程和医生偏好不一致。
启动婴儿减压质量改进（QI）团队：1993年，一个QI团队着手建议改变患者护理方式，以减轻新生儿在NICU的压力。鉴于新生儿护理的复杂性以及团队成员专业培训的多样性，医院聘请了一位心理学家开展为期两天的NICU培训项目，该项目强调应用当前关于应激源对婴儿生理和发育影响（即并发症）的研究结果。
护理方式的改变需要与受影响科室的医生和主任进行协商，大量重写政策，进行临床评估，申请额外物资，并开展全面的员工培训。NICU环境（如减少光线和噪音）、NICU入院流程（如放置脐动脉导管、婴儿四肢的屈曲姿势、热应激）、发育护理（如婴儿对安抚的需求、社交互动能力）以及吸痰程序（如仅在婴儿出现症状时而非按预设时间表进行吸痰和灌洗，保持婴儿头部中线位置而非左右转动）都发生了改变。
在实施团队建议后的六个月内发现了改善情况，支持了最初的假设，即重新设计程序和护理规程可以减轻NICU患者的压力。
