使用世卫组织孕产妇和新生儿保健质量评估/质量改进工具进行差距分析和POCQI方法,以改善三级保健中心的早产儿结局:一项质量改进倡议。

IF 1.6 Q4 HEALTH CARE SCIENCES & SERVICES
Kiran Suthar, Sushma Nangia, Pratima Anand, Harish Pemde
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引用次数: 0

摘要

前言:早产是全球新生儿死亡和发病的主要原因。有证据表明,四分之三以上的过早死亡可以通过具有成本效益的干预措施加以预防。然而,在新生儿护理中遵守循证指南往往不符合以下目标:该研究使用世卫组织孕产妇和新生儿护理质量评估/质量改进工具(WHO QA/QI MN)评估系统差距,并实施护理点质量改进(POCQI)方法,以改善和维持死亡率和/或主要发病率的综合结果,包括支气管肺发育不良、坏死性小肠结肠炎3期、迟发性败血症和≥3级脑室内出血。材料与方法:研究时间为14个月。采用经改编的世卫组织质量保证/质量保证MN工具和POCQI方法,重点关注关键临床实践,即袋鼠式母亲护理(KMC)、使用母乳(MoM)和抗生素使用,采用多种计划-实施-研究-行动周期。结果:961例入组早产儿中,KMC率从70.25%上升至85.58%,第7天使用纯妈率从59.24%上升至70.2%。抗生素使用率从25.5%下降到20.67%。虽然注意到过程的改进,但死亡率和主要发病率的综合结果在统计学上没有显着降低;然而,干预后观察到下降趋势。结论:本研究证明了训练有素的人员使用世卫组织工具进行差距分析的可行性。POCQI是在资源有限的环境中加强循证护理实践和维持早产儿良好结局的重要方法。可能需要更长的随访时间来观察临床结果的显著改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of WHO quality assessment/quality improvement tool for maternal and newborn care for gap analysis and POCQI methodology to improve preterm neonatal outcomes at a tertiary care centre: a quality improvement initiative.

Introduction: Preterm birth is a leading cause of neonatal mortality and morbidity globally. Evidence suggests that over three-quarters of premature deaths can be prevented through cost-effective interventions. However, compliance with evidence-based guidelines in neonatal care often falls <50%, even in well-resourced settings.

Aims and objectives: The study evaluated system gaps using WHO Quality Assessment/Quality Improvement Tool for Maternal and Newborn Care (WHO QA/QI MN) and implemented Point of Care Quality Improvement (POCQI) methodology to improve and sustain the composite outcome of mortality and/or major morbidities, including bronchopulmonary dysplasia, necrotising enterocolitis stage 3, late-onset sepsis and intraventricular haemorrhage grade ≥3.

Materials and methods: The study was conducted over 14 months. The adapted WHO QA/QI MN tool and POCQI methodology were used to focus on key clinical practices, namely, kangaroo mother care (KMC), use of mother's own milk (MoM) and antibiotic usage, utilising multiple plan-do-study-act cycles.

Results: Among 961 preterm neonates enrolled, KMC rates increased from 70.25% to 85.58%, and exclusive MoM use by day 7 increased from 59.24% to 70.2%. Antibiotic use declined from 25.5% to 20.67%. While process improvements were noted, the composite outcome of mortality and major morbidities did not show statistically significant reduction; however, a decreasing trend was observed post-intervention.

Conclusion: This study demonstrates the feasibility of using the WHO tool by trained personnel for gap analysis. POCQI is an important approach to enhance evidence-based care practices and sustain good outcomes for preterm neonates in resource-limited settings. A longer follow-up may be needed to observe significant improvements in clinical outcomes.

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来源期刊
BMJ Open Quality
BMJ Open Quality Nursing-Leadership and Management
CiteScore
2.20
自引率
0.00%
发文量
226
审稿时长
20 weeks
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