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Neonatal quality improvement

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https://www.readbyqxmd.com/read/29790141/-using-trm-to-enhance-the-accuracy-of-ventilator-associated-pneumonia-preventive-measures-implemented-by-neonatal-intensive-care-unit-medical-staffs
#1
Yu-Ting Huang, Chao-Ya Huang, Hsiu-Ya Su, Chen-Te Ma
BACKGROUND & PROBLEMS: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the neonatal intensive care unit (NICU). The average VAP infection density was 4.7‰ in our unit between June and August 2015. The results of a status survey indicated that in-service education lacked specialization, leading to inadequate awareness among staffs regarding the proper care of newborns with VAP and a lack of related care guides. This, in turn, resulted in inconsistencies in care measures for newborns with VAP...
June 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29788245/implementation-science-in-low-resource-settings-using-the-interactive-systems-framework-to-improve-hand-hygiene-in-a-tertiary-hospital-in-ghana
#2
Brianne Kallam, Christie Pettitt-Schieber, Medge Owen, Rebecca Agyare Asante, Elizabeth Darko, Rohit Ramaswamy
Quality issue: Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Initial assessment: Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections...
May 19, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29783977/effective-coverage-of-essential-inpatient-care-for-small-and-sick-newborns-in-a-high-mortality-urban-setting-a-cross-sectional-study-in-nairobi-city-county-kenya
#3
Georgina A V Murphy, David Gathara, Jacintah Mwachiro, Nancy Abuya, Jalemba Aluvaala, Mike English
BACKGROUND: Effective coverage requires that those in need can access skilled care supported by adequate resources. There are, however, few studies of effective coverage of facility-based neonatal care in low-income settings, despite the recognition that improving newborn survival is a global priority. METHODS: We used a detailed retrospective review of medical records for neonatal admissions to public, private not-for-profit (mission) and private-for-profit (private) sector facilities providing 24×7 inpatient neonatal care in Nairobi City County to estimate the proportion of small and sick newborns receiving nationally recommended care across six process domains...
May 22, 2018: BMC Medicine
https://www.readbyqxmd.com/read/29783270/reducing-alarm-fatigue-in-two-neonatal-intensive-care-units-through-a-quality-improvement-collaboration
#4
Kendall R Johnson, James I Hagadorn, David W Sink
OBJECTIVE:  To reduce nonactionable oximeter alarms by 80% without increasing time infants were hypoxemic (oxygen saturation [SpO2 ] ≤ 80%) or hyperoxemic (SpO2  > 95% while on supplemental oxygen). STUDY DESIGN:  In 2015, a multidisciplinary team at Connecticut Children's Medical Center initiated a quality improvement project to reduce nonactionable oximeter alarms in two referral neonatal intensive care units (NICUs). Changes made through improvement cycles included reduction of the low oximeter alarm limit for specific populations, increased low alarm delay, development of postmenstrual age-based alarm profiles, and updated bedside visual reminders...
May 21, 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29778713/concluding-commentary-on-current-trends-to-enhance-the-clinical-safety-of-pediatric-transfusion-focusing-on-prevention-of-untoward-complications-of-hsc-transplantation-newer-strategies-for-improving-the-standards-of-safety-quality-of-stem-cells-expansion-for
#5
REVIEW
Irena Sniecinski, Jerard Seghatchian
Clinical practice and related diagnostic, development and research [DDR] strategies in pediatric transfusion and transplantation cover a broad range of multidisciplinary studies, performed by many professionals involved in this most challenging clinical field [1]. This commentary on the current position and future perspectives in pediatric transfusion field is aimed to highlight major unresolved transfusion complications in pediatric patients, namely red blood cell and platelet alloimmunisation, and new ones such as nosocomial infection, thrombosis and multi-organ failure...
May 16, 2018: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29776004/knowledge-and-health-beliefs-about-gestational-diabetes-and-healthy-pregnancy-s-breastfeeding-intention
#6
Seungmi Park, Jung Lim Lee, Jang In Sun, Youngji Kim
AIMS AND OBJECTIVES: If the knowledge and health beliefs relating to gestational diabetes mellitus (GDM) during pregnancy are associated with behaviours during pregnancy and lactation, this suggests potential educational interventions. BACKGROUNDS: Women with GDM are more likely to develop type 2 diabetes mellitus (T2DM), and babies with GDM incur increased risk of neonatal hypoglycaemia and childhood obesity. Breastfeeding is an effective way to improve maternal and lipid metabolism of gestational diabetes mothers, and to lower the risk of T2DM after birth, to prevent conception...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29773123/circumstances-of-child-deaths-in-mali-and-uganda-a-community-based-confidential-enquiry
#7
Merlin L Willcox, Elias Kumbakumba, Drissa Diallo, Vincent Mubangizi, Peter Kirabira, Florence Nakaggwa, Birungi Mutahunga, Chiaka Diakité, Eugene Dembélé, Mamadou Traoré, Pierre Daou, Drissa Bamba, Amadou Traoré, Diafara Berthé, Nick Wooding, Kieran Dinwoodie, Sarah Capewell, Hamish Foster, Rowena Neville, Joseph Ngonzi, Jerome Kabakyenga, David Mant, Anthony Harnden
BACKGROUND: Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium Development Goal targets to be missed. We assessed whether a community enquiry into the circumstances of death could improve intervention effectiveness by identifying local avoidable factors and explaining implementation failures. METHODS: Deaths of children younger than 5 years were ascertained by community informants in two districts in Mali (762 deaths) and three districts in Uganda (442 deaths) in 2011-15...
June 2018: Lancet Global Health
https://www.readbyqxmd.com/read/29770557/developing-a-set-of-consensus-indicators-to-support-maternity-service-quality-improvement-using-core-outcome-set-methodology-including-a-delphi-process
#8
Kathryn J Bunch, Benjamin Allin, Matthew Jolly, Tom Hardie, Marian Knight
OBJECTIVE: To develop a core metric set to monitor the quality of maternity care. DESIGN: Delphi process followed by a face-to-face consensus meeting. SETTING: English Maternity units. POPULATION: Three representative expert panels: service designers, providers and users. MAIN OUTCOME MEASURES: Maternity care metrics judged important by participants. METHODS: Participants were asked to complete a two phase Delphi process, scoring metrics from existing local maternity dashboards...
May 16, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29767725/advancing-the-health-of-women-and-newborns-predictors-of-patient-satisfaction-among-women-attending-antenatal-and-maternity-care-in-rural-rwanda
#9
Christine Mutaganzwa, Leah Wibecan, Hari S Iyer, Evrard Nahimana, Anatole Manzi, Francois Biziyaremye, Merab Nyishime, Fulgence Nkikabahizi, Lisa R Hirschhorn, Hema Magge
Objective: Identify predictors of patient satisfaction with antenatal care (ANC) and maternity services in rural Rwanda. Design: Cross-sectional. Setting: Twenty-six health facilities in Southern Kayonza (SK) and Kirehe districts. Participants: Sample of women ≥ 16 years old receiving antenatal and delivery care between November and December 2013. Intervention: Survey of patient satisfaction with antenatal and delivery care to inform quality improvement (QI) initiatives aimed at reducing neonatal mortality...
May 15, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29759850/differences-in-prehospital-patient-assessments-for-pediatric-versus-adult-patients
#10
Sriram Ramgopal, Jonathan Elmer, Jeremiah Escajeda, Christian Martin-Gill
OBJECTIVE: To evaluate whether completion of vital signs assessments in pediatric transports by emergency medical services (EMS) differs by patient age. STUDY DESIGN: We reviewed records by 20 agencies in a regional EMS system in Southwestern Pennsylvania between April 1, 2013 and December 31, 2016. We abstracted demographics, vital signs (systolic blood pressure, heart rate, respiratory rate), clinical, and transport characteristics. We categorized age as neonates (≤30 days), infants (1 month to <1 year), toddler (1 to <2 years), early childhood (2 to <6 years), middle childhood (6 to <12 years), adolescent (12 to <18 years), and adult (≥18 years)...
May 11, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29756290/a-standardized-closed-loop-system-for-monitoring-pediatric-tracheostomy-related-adverse-events
#11
Mallory McKeon, Daphne Munhall, Brian K Walsh, Roger Nuss, Reza Rahbar, Mark Volk, Karen Watters
OBJECTIVES/HYPOTHESIS: Advancement in neonatal and pediatric intensive care has increased the need for chronic-care interventions, including tracheostomy. It is well established that children with a tracheostomy are at a high risk for adverse events, many of which are preventable. Despite this, there is no standardized method of monitoring tracheostomy-related adverse events (TRAEs). Our objective was to describe and assess a standardized, closed-loop system for monitoring TRAEs. STUDY DESIGN: Prospective Study...
May 14, 2018: Laryngoscope
https://www.readbyqxmd.com/read/29756072/managing-antibiotics-wisely-a-quality-improvement-programme-in-a-tertiary-neonatal-unit-in-the-uk
#12
Vasiliki Makri, Gemma Davies, Stephanie Cannell, Katherine Willson, Lucy Winterson, Joanna Webb, Amit Kandhari, Maha Mansour, Joanne Thomas, Geraint Morris, Jean Matthes, Sujoy Banerjee
Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic overuse and limited investment in new antibiotic research. Inappropriate perinatal antibiotic exposure is increasingly linked to lifelong adverse outcomes through its impact on the developing microbiome. Antibiotic stewardship may be the only effective preventative strategy currently available. As the first tertiary neonatal unit in the UK to collaborate in an international quality improvement programme (QIP) with Vermont Oxford Network (VON), we present the results of our antibiotic stewardship initiative...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29748454/analysis-of-the-changes-in-the-polish-universal-neonatal-hearing-screening-program-over-15-years-of-activity
#13
Grażyna Greczka, Monika Zych, Witold Szyfter, Maciej Wróbel
INTRODUCTION: One of the examples of a nationwide pro-health program in Poland is the Polish Universal Neonatal Hearing Screening Program (PUNHSP). The Program is aimed at early diagnosis and intervention in children with hearing impairments and it is an example of a well-managed program. Presenting the results of the PUNHSP activity as well as organizational aspects and own experience can significantly help institutions managing other programs to achieve high efficiency in their functioning...
April 30, 2018: Otolaryngologia Polska
https://www.readbyqxmd.com/read/29747880/quality-improvement-in-perinatal-medicine-and-translation-of-preterm-birth-research-findings-into-clinical-care
#14
REVIEW
Tracy A Manuck, Rebecca C Fry, Barbara L McFarlin
Billions of dollars are spent yearly in perinatal medicine on studies designed to improve outcomes for mothers and their neonates. However, implementing research findings is challenging and imperfect. Strategies for implementation must be multifaceted and comprehensive. These implementation challenges extend to, and are often greater in, translational and basic science research. The purpose of this review is to discuss current challenges in the provision of quality perinatal and neonatal medical care, particularly those related to preterm birth, and provide examples of prematurity-related perinatal quality collaborative initiatives...
June 2018: Clinics in Perinatology
https://www.readbyqxmd.com/read/29742551/exploring-research-topics-and-trends-in-nursing-related-communication-in-intensive-care-units-using-social-network-analysis
#15
Youn-Jung Son, Soo-Kyoung Lee, SeJin Nam, Jae Lan Shim
This study used social network analysis to identify the main research topics and trends in nursing-related communication in intensive care units. Keywords from January 1967 to June 2016 were extracted from PubMed using Medical Subject Headings terms. Social network analysis was performed using Gephi software. Research publications and newly emerging topics in nursing-related communication in intensive care units were classified into five chronological phases. After the weighting was adjusted, the top five keyword searches were "conflict," "length of stay," "nursing continuing education," "family," and "nurses...
May 4, 2018: Computers, Informatics, Nursing: CIN
https://www.readbyqxmd.com/read/29741208/induction-of-labour-for-improving-birth-outcomes-for-women-at-or-beyond-term
#16
REVIEW
Philippa Middleton, Emily Shepherd, Caroline A Crowther
BACKGROUND: Beyond term, the risks of stillbirth or neonatal death increase. It is unclear whether a policy of labour induction can reduce these risks. This Cochrane review is an update of a review that was originally published in 2006 and subsequently updated in 2012 OBJECTIVES: To assess the effects of a policy of labour induction at or beyond term compared with a policy of awaiting spontaneous labour or until an indication for birth induction of labour is identified) on pregnancy outcomes for infant and mother...
May 9, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29740196/quality-improvement-initiative-to-improve-inpatient-outcomes-for-neonatal-abstinence-syndrome
#17
Elisha M Wachman, Matthew Grossman, Davida M Schiff, Barbara L Philipp, Susan Minear, Elizabeth Hutton, Kelley Saia, Fnu Nikita, Ahmad Khattab, Angela Nolin, Crystal Alvarez, Karan Barry, Ginny Combs, Donna Stickney, Jennifer Driscoll, Robin Humphreys, Judith Burke, Camilla Farrell, Hira Shrestha, Bonny L Whalen
OBJECTIVES: To improve Neonatal Abstinence Syndrome (NAS) inpatient outcomes through a comprehensive quality improvement (QI) program. DESIGN: Inclusion criteria were opioid-exposed infants ≥36 weeks. QI methodology including stakeholder interviews and plan-do-study-act (PDSA) cycles were utilized. We compared pre- and post-intervention NAS outcomes after a QI initiative that included: A non-pharmacologic care bundle, function-based assessments consisting of symptom prioritization and then the "Eat, Sleep, Console" (ESC) Tool; and a switch to methadone for pharmacologic treatment...
May 8, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29739104/prevalence-of-glucose-6-phosphate-dehydrogenase-deficiency-in-sichuan-china
#18
Jing Zhang, Yali Cui, Xia Wang, Yingying Li, Dongmei Jiang, Wei Dai, Yongmei Jiang
BACKGROUND: Our goals were to screen newborns and characterize the occurrence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in southwestern China. Meanwhile, we would like to analyze the factors that might affect the results of neonatal dried blood spots for glucose-6-phosphate dehydrogenase screening test, to improve the clinical quality control level, effectively reduce the external factors in the process of detection. METHODS: This study involved an evaluation of G6PD data for 20,644 newborns from a universal newborn screening program...
March 1, 2018: Clinical Laboratory
https://www.readbyqxmd.com/read/29737274/antiepileptic-drug-monitoring-in-pregnancy-empire-a-double-blind-randomised-trial-on-effectiveness-and-acceptability-of-monitoring-strategies
#19
Shakila Thangaratinam, Nadine Marlin, Sian Newton, Annalise Weckesser, Manny Bagary, Lynette Greenhill, Rachel Rikunenko, Maria D'Amico, Ewelina Rogozińska, Andrew Kelso, Kelly Hard, Jamie Coleman, Ngawai Moss, Tracy Roberts, Lee Middleton, Julie Dodds, Angela Pullen, Sandra Eldridge, Alexander Pirie, Elaine Denny, Doug McCorry, Khalid S Khan
BACKGROUND: Pregnant women with epilepsy on antiepileptic drugs (AEDs) may experience a reduction in serum AED levels. This has the potential to worsen seizure control. OBJECTIVE: To determine if, in pregnant women with epilepsy on AEDs, additional therapeutic drug monitoring reduces seizure deterioration compared with clinical features monitoring after a reduction in serum AED levels. DESIGN: A double-blind, randomised trial nested within a cohort study was conducted and a qualitative study of acceptability of the two strategies was undertaken...
May 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29732577/estimated-fetal-weight-percentile-as-a-tool-to-predict-collection-of-cord-blood-units-with-higher-cellular-content-implications-for-prenatal-selection-of-cord-blood-donors
#20
Xinxin Lin, Marta Torrabadella, Lluís Amat, Susana Gómez, Carmen Azqueta, Mar Sánchez, Daniel Cuadras, Maria José Martínez Lorenzo, José María Brull, Antoni Gayà, Arantxa Cemborain, Cristina Pérez Garcia, JoséLuís Arroyo, Sergi Querol, Maria Dolores Gómez Roig
BACKGROUND: The need for high-cellular-content cord blood units (CBUs) for allogenic transplantation is evident to improve clinical outcomes. In our environment and with current donation programs, very few collected units meet suggested clinical thresholds, making collection programs highly inefficient. To increase the clinical conversion rate, we have assessed factors influencing the cellular content of the cord blood collection and established the estimated fetal weight percentile (EFWp) as a tool to predict which deliveries will obtain higher cellular counts...
May 6, 2018: Transfusion
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