Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2006
A systems approach for neonatal hyperbilirubinemia in term and near-term newborns.
Оценочное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Bhutani Vinod K, Johnson Lois H, Schwoebel Ann, Gennaro Susan
Аннотация
OBJECTIVE: To propose and implement a family-centered systems approach to manage newborn jaundice for safer outcomes.
DESIGN: Observational study for known adverse outcomes.
SETTING: Semiprivate urban birthing hospital.
PATIENTS/PARTICIPANTS: 31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000).
INTERVENTIONS: Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin).
MAIN OUTCOME MEASURES: Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation.
RESULTS: Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625.
CONCLUSIONS: Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.
DESIGN: Observational study for known adverse outcomes.
SETTING: Semiprivate urban birthing hospital.
PATIENTS/PARTICIPANTS: 31,059 well babies discharged as healthy from a cohort of 41,961 live births (1990-2000).
INTERVENTIONS: Incremental implementation of a systems approach that incorporated a hospital policy to (a) authorize nurses to obtain a bilirubin (total serum/transcutaneous) measurement for clinical jaundice, (b) universal predischarge total serum bilirubin (at routine metabolic screening), and (c) targeted follow-up, using the bilirubin nomogram (hour-specific, percentile-based total serum bilirubin/transcutaneous bilirubin).
MAIN OUTCOME MEASURES: Known adverse outcomes assessed for early- and late-onset severe hyperbilirubinemia before, during, and after systems approach implementation.
RESULTS: Adverse outcomes decreased for well babies: exchange transfusion, intensive phototherapy, and readmission. During the study period, there were no "never events" (total serum bilirubin greater than or equal to 30 mg/dl), while "close calls" (total serum bilirubin greater than or equal to 25 mg/dl) were 1 in 15,000 as compared to a reported incidence of 1 in 625.
CONCLUSIONS: Reduced adverse events, significant reduction in close calls, and no never events met family expectations for safer experiences with this approach.
Предметные рубрики MeSH
AftercareAlgorithmsBilirubinBreast FeedingCritical PathwaysDecision TreesHumansHyperbilirubinemia, NeonatalInfant, NewbornInfant, Premature, DiseasesNeonatal NursingNeonatal ScreeningNurse's RoleNursing AssessmentNursing Evaluation ResearchOutcome Assessment, Health CareParentsPatient DischargePatient ReadmissionPatient-Centered CarePractice Guidelines as TopicProfessional AutonomySystems Analysis