ABSTRACT
Objective:To analyze the effect of SBAR (situation, background, assessment, and recommendation) sign-out template in the standardized residency training in a neonatal ward.Methods:Based on SBAR communication mode, we designed and optimized neonatal ward sign-out checklist, and a total of 67 residents were trained for 2 weeks from April 2019 to June 2019, with control group (before training) and observation group (after training). The assessment indicators of sign-out information included sign-out duration, the incidence of sign-out errors, quality assessment scores and shift satisfaction (including sign-out satisfaction and self-evaluation) as well as competencies. A total of 1 553 children's morning shift data were collected, and SPSS 22. 0 was used for t test and chi-square test. Results:In the control group, the sign-out duration was (23.4±4.7) min, the incidence of sign-out errors was (43.6±6.6)%, quality assessment scores were (6.3±0.7) points, the satisfaction degree was (76.5±4.6)%, and the self-evaluation scores were (5.2±2.1) points. While, in the observation group, the sign-out duration was (15.9±3.2) min, the incidence of sign-out errors was (21.1±2.3)%, quality assessment scores were (8.9±0.9) points, the satisfaction degree was (94.1±2.9)%, and the self-evaluation scores were (8.9±0.8) points, with statistically significant difference ( P<0.05). There were statistically significant differences between the two groups in clinical skills and medical service ability [(2.2±0.1) vs. (3.8±0.3)], interpersonal communication ability [(2.6±0.5) vs. (4.2±0.1) points], teamwork ability [(3.1±0.2) vs. (4.6±0.3)], information and management ability [(2.5±0.5) vs. (4.2±0.2)] ( P<0.05). Conclusion:The SBAR template can improve sign-out process and the clinical skills of standardized training residents.
ABSTRACT
Objective To explore the risk factors of acute kidney injury (AKI) in very low birth weight (VLBW) infants. Method The clinical data of 313 VLBW newborns aged under 3 days from January 2012 to December 2016 were retrospectively analyzed. According to the improved KDIGO standard of neonatal AKI, the difference between AKI (group AKI) and non AKI (group NAKI) newborns was compared, and the risk factors of AKI and mortality of AKI infants were analyzed. Results In the 313 VLBW infants, 126 had AKI and the incidence rate was 40.3％. There were 53 cases at stage 1 (42.1％), 43 cases at stage 2 (34.1％), and 30 cases at stage 3 (23.8％). Compared with NAKI group, patients in AKI group were lower in gestational age, birth weight, 5-minute Apgar score, critical score and mean arterial pressure. Furthermore, AKI group was higher in mother's age, incidence of premature rupture of membranes and respiratory failure. Also, white blood cells number and procalcitonin level were higher; albumin and sodium levels were lower; more cases had invasive mechanical ventilation after birth; time of mechanical ventilation was longer; mortality were higher in AKI group. There were statistically differences (P<0.05). Multivariate logistic regression analysis showed that gestational age, respiratory failure and invasive mechanical ventilation at birth were independent risk factors for AKI in VLBW infants. More severe acidosis and associated pulmonary hemorrhage at admission were the independent risk factors for the death caused by AKI in children. Conclusions Short gestational age, respiratory failure, and invasive mechanical ventilation at birth significantly increased the risk of AKI in VLBW infants. The more severe metabolic acidosis and pulmonary hemorrhage increased the risk of death in AKI children .