缩小液体间隙:改善社区医院网络中静脉液体的使用。

IF 1.2 Q3 PEDIATRICS
Pediatric quality & safety Pub Date : 2023-10-07 eCollection Date: 2023-09-01 DOI:10.1097/pq9.0000000000000696
Shraddha Mittal, Sheila Knerr, Julianne Prasto, Jessica Hunt, Carolyn Mattern, Tsae Chang, Ronald Marchese, Morgan Jessee, Lauren Marlowe, Josh Haupt
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引用次数: 0

摘要

简介:美国儿科学会建议使用等渗静脉输液(IVF)进行维持,以降低低钠血症的风险。我们进行了一个质量改进项目,在12个月内将社区医院网络中三个站点收治的儿科患者使用等渗维持IVF的比例提高到85%以上。方法:我们采用改进方法来确定持续使用低渗液的原因,包括提供者行为和系统因素。我们采取了干预措施来解决这些因素,包括:(1)教育;(2) 临床决策支持;以及(3)储存具有等渗IVF的自动药物分配系统。我们比较了所有年龄在28天至18岁的住院患者在干预前后使用等渗试管婴儿的情况,这些患者接受了至少10 毫升/小时。我们排除了患有糖尿病酮症酸中毒等活动性慢性疾病的患者入院。平衡措施是发生低钠血症或高钠血症的不良事件。使用Laney P的统计过程控制图对数据进行分析。结果:在所有三个部位需要维持液的患者中,同位素试管婴儿的使用在12个月内超过了>85%的目标。没有与使用等渗试管婴儿相关的低钠血症或高钠血症或其他不良后果的报告。结论:针对提供者行为和系统因素的干预措施相结合,对于成功采用美国儿科学会关于住院儿童使用维持等渗试管受精的指南至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Closing the Fluid Gap: Improving Isotonic Maintenance Intravenous Fluid Use in a Community Hospital Network.

Closing the Fluid Gap: Improving Isotonic Maintenance Intravenous Fluid Use in a Community Hospital Network.

Closing the Fluid Gap: Improving Isotonic Maintenance Intravenous Fluid Use in a Community Hospital Network.

Closing the Fluid Gap: Improving Isotonic Maintenance Intravenous Fluid Use in a Community Hospital Network.

Introduction: The American Academy of Pediatrics recommends using isotonic intravenous fluids (IVF) for maintenance needs to decrease the risk of hyponatremia. We conducted a quality improvement project to increase the use of isotonic maintenance IVF in pediatric patients admitted to three sites in a community hospital network to >85% within 12 months.

Methods: We used improvement methodology to identify causes of continued hypotonic fluid use, which involved provider behavior and systems factors. We implemented interventions to address these factors including: (1) education; (2) clinical decision support; and (3) stocking automated medication dispensing systems with isotonic IVF. We compared isotonic IVF use before and after interventions in all admitted patients aged 28 days to 18 years who received maintenance IVFs at the rate of at least 10 mL/hour. We excluded admissions of patients with active chronic medical conditions like diabetic ketoacidosis. Balancing measures were the occurrence of adverse events from hypo- or hypernatremia. Data were analyzed using Laney P' statistical process control charts.

Results: Isotonic IVF use among patients requiring maintenance fluids at all three sites surpassed the goal of >85% within 12 months. There were no reports of hypo- or hypernatremia or other adverse outcomes related to the use of isotonic IVF.

Conclusion: A combination of interventions aimed at provider behavior and systems factors was critical to successfully adopting the American Academy of Pediatrics guideline regarding the use of maintenance isotonic IVF in hospitalized children.

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CiteScore
2.20
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