Antibiotic stewardship and nosocomial infection prevention in critically ill patients: a quality improvement program

SUMMARY OBJECTIVE: The objective of this study was to evaluate the impact of the implementation of a bundle of interventions through a "Program for Antibiotic Management and Nosocomial Infection Prevention" in the intensive care unit on antibiotic and devices use and healthcare-associated infections. METHODS: This was a quasi-experimental study of consecutive series of cases in periods before and after the establishment of protocols and checklists for the use of antibiotics as well as other measures to prevent healthcare-associated infection as part of a quality improvement program. Antimicrobial consumption was assessed by the defined daily dose. RESULTS: A total of 1,056 and 1,323 admissions in the pre-intervention and post-intervention phases, respectively, were evaluated. The defined daily dose per 100 patient-day decreased from 89±8 to 77±11 (p=0.100), with a decrease in carbapenems, glycopeptides, polymyxins, penicillins, and cephalosporins. The rates of ventilator and central venous catheter use decreased from 52.8 to 44.1% and from 76 to 70%, respectively. The rates of healthcare-associated infection decreased from 19.2 to 15.5%. CONCLUSION: Quality improvement actions focused primarily on antimicrobial management and prevention of healthcare-associated infection are feasible and have the potential to decrease antibiotic use and healthcare-associated infection rates.

Improvement in the quality of pressure injury prevention in an intensive care unit / Mejora de la calidad de la prevención de lesiones por presión en una unidad de cuidados intensivos / Melhoria da qualidade da prevenção de lesão por pressão em uma unidade de terapia intensiva

ABSTRACT Objective: to assess the effect of implementing a quality improvement project on the process of pressure injury prevention in an adult Intensive Care Unit. Method: a quality improvement project for the pressure injury prevention process was carried out in an adult Intensive Care Unit of a public hospital from November 2022 to July 2023. It was developed following the steps of an improvement cycle. The quality level of pressure injury prevention was measured before and after the interventions, using six quality criteria. Data collection for the first assessment was conducted in March 2023, retrospectively, referring to November and December 2022 and January 2023. Quality reassessment occurred in July 2023, also retrospectively, referring to April, May, and June 2023. Interventions included changes in records related to assistance in pressure injury prevention and education/awareness of the team on pressure injury prevention. Results: the initial quality assessment showed that the compliance level of pressure injury prevention was low, with virtually all criteria showing rates below 50%. After the interventions, there was an increase in compliance with almost all criteria. Conclusion: the use of a quality improvement project enabled the improvement of the pressure injury prevention process and contributed to the scientific community by corroborating the effectiveness of these projects in implementing pressure injury prevention programs, as well as prompting reflection on the multifactorial nature involved in this preventive process.

RESUMEN Objetivo: evaluar el efecto de la implementación de un proyecto de mejora de la calidad en el proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos. Método: se llevó a cabo un proyecto de mejora de la calidad del proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos de un hospital público, entre noviembre de 2022 y julio de 2023. Este proyecto se desarrolló siguiendo las etapas de un ciclo de mejora. El nivel de calidad en la prevención de lesiones por presión se midió antes y después de las intervenciones, utilizando seis criterios de calidad. La recopilación de datos para la primera evaluación se realizó en marzo de 2023, retrospectivamente, para los meses de noviembre y diciembre de 2022 y enero de 2023. La reevaluación de la calidad se llevó a cabo en julio de 2023, también retrospectivamente, para los meses de abril, mayo y junio de 2023. Las intervenciones incluyeron cambios en los registros relacionados con la asistencia en la prevención de lesiones por presión y la educación/concientización del equipo sobre la prevención de lesiones por presión. Resultados: la evaluación inicial de la calidad mostró que el nivel de conformidad en la prevención de lesiones por presión era bajo, con casi todos los criterios presentando tasas inferiores al 50%. Después de las intervenciones, hubo un aumento en la conformidad en casi todos los criterios. Conclusión: el uso de un proyecto de mejora de la calidad permitió mejorar el proceso de prevención de lesiones por presión y contribuyó con la comunidad científica, al corroborar la eficacia de estos proyectos en la implementación de programas de prevención de lesiones por presión, así como para promover la reflexión sobre los múltiples factores involucrados en este proceso preventivo.

RESUMO Objetivo: Avaliar o efeito da implementação de um projeto de melhoria da qualidade no processo de prevenção de lesão por pressão numa Unidade de Terapia Intensiva adulto. Método: Projeto de melhoria da qualidade do processo de prevenção de lesão por pressão, realizado em uma Unidade de Terapia Intensiva adulto, de um hospital público, no período de novembro/2022 a julho/2023. Foi desenvolvido seguindo as etapas de um ciclo de melhoria. O nível de qualidade da prevenção de lesão por pressão foi medido antes e depois das intervenções, utilizando seis critérios de qualidade. A coleta de dados da primeira avaliação foi realizada em março/2023, de forma retrospectiva, referente aos meses de novembro e dezembro/2022 e janeiro/2023. A reavaliação de qualidade ocorreu em julho de 2023, também de forma retrospectiva, referente aos meses de abril, maio e junho/2023. As intervenções incluíram mudanças nos registros relacionados à assistência na prevenção de LP e educação/sensibilização da equipe sobre prevenção de lesão por pressão. Resultados: A avaliação inicial da qualidade mostrou que o nível de conformidade de prevenção de lesão por pressão era baixo, com praticamente todos os critérios apresentando taxas inferiores a 50%. Após as intervenções, houve aumento na conformidade de quase todos os critérios. Conclusão: A utilização de um projeto de melhoria de qualidade possibilitou a melhora do processo de prevenção de lesão por pressão e contribuiu com a comunidade científica, ao corroborar a eficácia destes projetos na implementação de programas de prevenção lesão por pressão, bem como incitou a reflexão acerca da multifatorialidade envolvida neste processo preventivo.

Educação permanente para qualidade e segurança do paciente em hospital acreditado / Educación permanente para calidad y seguridad del paciente en hospital acreditado / Permanent education for quality and patient safety in an accredited hospital

Resumo Objetivo Compreender os desafios enfrentados pela educação permanente para o alcance da melhoria da qualidade e da segurança do paciente em um hospital público submetido à acreditação hospitalar. Métodos Estudo descritivo, transversal e com abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 22 profissionais, durando, em média, 22 minutos, as quais posteriormente foram analisadas e interpretadas por meio da análise de conteúdo temática de Bardin. Adotaram-se os softwares Iramuteq para a análise de corpus textual, e o BioEstat 5.3, para análise do perfil dos participantes. A coleta de dados ocorreu em junho de 2022, após aprovação nos Comitês de Ética em Pesquisa. Resultados Aplicou-se a análise de classificação hierárquica descendente, gerada pelo Iramuteq. Obtiveram-se três categorias: Desafios da Educação Permanente mediante o Processo de Melhoria Contínua; Educação Permanente para a Promoção da Qualidade e da Segurança do Paciente no Contexto da Acreditação Hospitalar; e Estratégias Educativas para a Melhoria da Qualidade e da Segurança do Paciente. Conclusão Identificaram-se desafios inerentes às ações de educação permanente em saúde, tais como resistência à mudança de cultura, adesão às atividades, alta rotatividade de profissionais e dificuldade para liberação da equipe de enfermagem para participar das atividades relacionadas à demanda de trabalho.

Resumen Objetivo Comprender los desafíos enfrentados por la educación permanente para lograr mejorar la calidad y la seguridad del paciente en un hospital público sometido a acreditación hospitalaria. Métodos Estudio descriptivo, transversal y con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 22 profesionales, con duración promedio de 22 minutos, que luego se analizaron e interpretaron mediante el análisis de contenido temático de Bardin. Se utilizaron los softwares Iramuteq para el análisis de corpus textual y BioEstat 5.3 para el análisis del perfil de los participantes. La recopilación de datos se llevó a cabo en junio de 2022, después de la aprobación de los Comités de Ética en Investigación. Resultados Se aplicó el análisis de clasificación jerárquica descendente, generado por Iramuteq. Se obtuvieron tres categorías: Desafíos de la educación permanente mediante el proceso de mejora continua, Educación permanente para la promoción de la calidad y de la seguridad del paciente en el contexto de la acreditación hospitalaria, y Estrategias educativas para la mejora de la calidad y la seguridad del paciente. Conclusión Se identificaron desafíos inherentes a las acciones de educación permanente en salud, tales como resistencia a cambios de cultura, adherencia a las actividades, alta rotación de profesionales y dificultad de autorizar al equipo de enfermería para participar en las actividades relacionadas con la demanda de trabajo.

Abstract Objective To understand the challenges faced in terms of permanent education in health, for achieving quality improvements and patient safety at a public hospital undergoing hospital accreditation. Methods This was a descriptive, cross-sectional study with a qualitative approach. Semi-structured interviews were conducted with 22 professionals, lasting an average of 22 minutes. The interviews were subsequently analyzed and interpreted using Bardin's thematic content analysis. The software Iramuteq was used to analyze the textual corpus, and BioEstat 5.3 was used to analyze the profile of the participants. The data collection took place in June 2022, following approval by the Research Ethics Committees. Results The descending hierarchical classification analysis, generated by Iramuteq, was applied, resulting in three categories: Challenges of Permanent Education through the Continuous Improvement Process, Permanent Education for the Promotion of Quality and Patient Safety in the Context of Hospital Accreditation, and Educational Strategies for Improving Quality and Patient Safety. Conclusion Challenges inherent to the actions of permanent education in health were identified, such as resistance to cultural change, adherence to activities, high turnover of professionals, and difficulty in releasing the nursing team to participate in activities, due to work demand.

Aseguramiento y control de la calidad de los datos en un estudio de cohorte en Colombia

Introducción: La calidad de los datos facilita garantizar la fiabilidad de los estudios observacionales. Objetivo: Describir el aseguramiento y el control de calidad para mantener la fiabilidad y la validez del dato en un estudio de cohorte. Métodos: Presentar el manejo de datos implementado dentro de un seguimiento de enfermos renales crónicos cuya exposición fue un programa de protección renal comparado con el tratamiento convencional y su asociación con desenlaces clínicos. Se evaluó el cambio en la frecuencia de errores después de implementar el plan y la reproducibilidad del ingreso de registros a las bases de datos. Resultados: Se documentó una disminución progresiva en los errores cometidos en la captación de datos. El valor de Kappa entre los recolectores de la información para las variables clínicas más importantes fue 0,960 para la depuración de creatinina 150 mg/dL; 0,730 para la alteración del sedimento urinario; 0,956 para la asignación de estadio al ingreso. Los coeficientes de correlación intraclase para la identificación de las cifras de presión arterial sistólica fue 0,996; para la de presión arterial diastólica 0,993 y para los niveles de creatinina sérica al diagnóstico 0,995. Discusión: La calidad de los datos comienza con el reconocimiento de los retos y dificultades que implica su responsable captación, de ahí el aporte de la estandarización de los procesos y el personal que los lleve a cabo en forma idónea. Estudios evidencian que muchos procesos de mejora surgen en el desarrollo de la investigación sin protocolos preestablecidos. Conclusión: La reducción en la proporción y el tipo de error durante el proceso de captación de datos se debe a su identificación temprana y la corrección de instructivos, del instrumento de control de diligenciamiento y de la capacitación continua del personal. El análisis mostró una buena concordancia interevaluador.

Introduction: Data quality makes it easier to ensure that observational studies are reliable. Objective: To describe assurance and quality control to maintain data reliability and validity in a cohort study. Methodology: We present the data management strategies implemented in a study that followed patients of chronic kidney disease who were in a renal protection program and compared them with those undergoing conventional treatment to observe its association with clinical outcomes. We assessed the changes in error frequency after implementing the plan along with the reproducibility of the strategies for entering records into the databases. Results: We documented a progressive decrease of data collection errors. The Kappa values among data collectors for the most important variables were: 0.960 for creatinine clearance 150 mg/dl; 0.730 for urinary sediment alteration and 0.956 for stage allocation upon admission. The intraclass correlation coefficient for the identification of systolic blood pressure was 0.996; for diastolic blood pressure, the coefficient was 0.993 and for serum creatinine levels at diagnosis, the value was 0.995. Discussion: Data quality begins with the recognition of the challenges and difficulties involved in responsible data collection, hence the contribution of standardized processes and personnel to carry them out in a suitable manner. Studies show that many improvement processes arise in the development of research without pre-established protocols. Conclusion: The reduction in error ratio and type during the data collection process are the result of the early identification of erroneously entered or missing data, the correction of the guidelines for completing forms as well as of the instruments for detecting errors and continuous training of the staff. The analysis showed good inter-rater reliability.

Priorities and root cause analysis of quality and safety problems in chilean hospitals / Prioridades y análisis de las causas de los problemas de calidad y seguridad en hospitales chilenos

BACKGROUND: Quality improvement is an important component of hospital operations. AIM: To prioritise clinical quality and safety problems in Chilean hospitals according to their severity, frequency, and detectability. MATERIAL AND METHODS: The study was conducted between December 2018 and June 2019. To identify quality and safety problems, an exploratory study was conducted using an online survey aimed to those responsible for clinical quality and safety in Chilean hospitals. The survey was sent to 94 hospitals and completed by quality management personnel at 34 hospitals, yielding a total of 25 valid surveys for analysis. Based on the information gathered, a risk priority score was computed to rank the problems surveyed. Focus groups were held to find the root causes of the quality and safety problem with the highest risk priority score. RESULTS: The three highest risk priorities were:1 ineffective interprofessional communication,2 lack of leadership for addressing frequently recurring safety issues, and3 antimicrobial resistance due to inappropriate use of antibiotics. For the communication problem, the focus group found two main root causes: those due to personnel and those relating to the hospitals themselves. CONCLUSIONS: Hospitals can systematically use the proposed approach to categorize their main clinical quality and safety problems, analyze their causes, and then design solutions.

ANTECEDENTES: La mejora continua de la calidad es un componente importante en las actividades hospitalarias. OBJETIVO: Priorizar los problemas de calidad y seguridad en hospitales chilenos de acuerdo a su severidad, frecuencia y detectabilidad. MATERIAL Y MÉTODOS: Se efectuó un estudio exploratorio con una encuesta en línea para detectar problemas de calidad y seguridad, dirigida a quienes están a cargo de los problemas de calidad y seguridad en los hospitales. La encuesta fue enviada a 94 hospitales y respondida por los encargados de calidad y seguridad en 34 de ellos, lográndose 25 encuestas válidas para análisis. El estudio se llevó a cabo entre diciembre de 2018 y junio de 2019. Se diseñó una escala de prioridades de riesgo para determinar la importancia relativa de los problemas detectados. Se llevaron a cabo grupos focales para determinar las causas del problema más importante. RESULTADOS: En Chile, los problemas de calidad y seguridad más importantes son la falta de comunicación interprofesional, falta de liderazgo para abordar los problemas de seguridad y calidad, y resistencia a antibióticos debido a su uso inapropiado. Problemas relacionados al personal y relacionados al hospital fueron las causas primarias de la falta de comunicación. CONCLUSIONES: Los hospitales podrían utilizar este enfoque de forma sistemática para categorizar sus principales problemas de calidad y seguridad, analizar las causas y diseñar soluciones.

O preparo intestinal em dose dividida é superior à dose direta em pacientes hospitalizados submetidos à colonoscopia hospitalar / Split-dose bowel preparation is superior to straight-dose in hospitalized patients undergoing inpatient colonoscopy

ABSTRACT Background: There is a two-fold higher rate of failed colonoscopy secondary to inadequate bowel preparation among hospitalized versus ambulatory patients. Split-dose bowel preparation is widely used in the outpatient setting but has not been generally adapted for use among the inpatient population. Objective The aim of this study is to evaluate the effectiveness of split versus single dose polyethylene glycol bowel (PEG) preparation for inpatient colonoscopies and determine additional procedural and patient characteristics that drive inpatient colonoscopy quality. Methods: A retrospective cohort study was performed on 189 patients who underwent inpatient colonoscopy and received 4 liters PEG as either split- or straight-dose during a 6-month period in 2017 at an academic medical center. Bowel preparation quality was assessed using Boston Bowel Preparation Score (BBPS), Aronchick Score, and reported adequacy of preparation. Results: Bowel preparation was reported as adequate in 89% of the split-dose group versus 66% in the straight-dose group (P=0.0003). Inadequate bowel preparations were documented in 34.2% of the single-dose group and 10.7% of the split-dose group (P<0.001). Only 40% of patients received split-dose PEG. Mean BBPS was significantly lower in the straight-dose group (Total: 6.32 vs 7.73, P<0.001). Conclusion: Split-dose bowel preparation is superior to straight-dose preparation across reportable quality metrics for non-screening colonoscopies and was readily performed in the inpatient setting. Interventions should be targeted at shifting the culture of gastroenterologist prescribing practices towards use of split-dose bowel preparation for inpatient colonoscopy.

RESUMO Contexto: Há uma taxa duas vezes maior de colonoscopia com falha secundária ao preparo intestinal inadequado entre pacientes hospitalizados versus ambulatoriais. O preparo intestinal em dose dividida é amplamente utilizado em ambulatório, mas geralmente não foi adaptado para uso entre a população hospitalar. Objetivo: O objetivo deste estudo é avaliar a eficácia da preparação do intestino de polietilenoglicol (PEG) em dose única versus doses separadas para colonoscopias hospitalares e determinar características adicionais do procedimento e do paciente que promovam a qualidade da colonoscopia do paciente internado. Métodos Um estudo de coorte retrospectivo foi realizado em 189 pacientes que foram submetidos a colonoscopia hospitalar e receberam 4 litros de PEG como dose dividida ou direta durante um período de 6 meses em 2017 em um centro médico acadêmico. A qualidade do preparo intestinal foi avaliada usando-se o Boston Bowel Preparation Score (BBPS), o Aronchick Score, e relatório sobre a adequação do preparo. Resultados O preparo intestinal foi relatado como adequado em 89% do grupo de dose dividida versus 66% no grupo de dose direta (P=0,0003). Preparações intestinais inadequadas foram documentadas em 34,2% do grupo de dose única e 10,7% do grupo de dose dividida (P<0,001). Apenas 40% dos pacientes receberam PEG em dose fracionada. O BBPS médio foi significativamente menor no grupo de dose direta (total: 6,32 vs 7,73, P<0,001). Conclusão O preparo intestinal em dose dividida é superior ao preparo de dose única em todas as métricas de qualidade relacionadas para colonoscopias sem triagem e foi adequadamente realizado no ambiente de internação. As intervenções devem ser direcionadas para mudar a cultura das práticas de prescrição de gastroenterologistas para o uso de preparação intestinal em dose dividida para colonoscopia hospitalar.

Antibiotic consumption history of patients in a referred laboratory in Yaounde

Background. Regulation of antibiotic prescription and consumption remain a major public health burden in low- and middle-income country. This study aimed to describe the antibiotic consumption of patients who had a positive antibiotic culture in a reference laboratory. Methods. A retrospective descriptive study was conducted among 113 participants with positive antibiogram with a documented history of antibiotics intake at the Yaoundé University Teaching Hospital (YUTH) in Cameroon between January 2016 to June 2021. Data were stored and analyzed using the Census and Survey Processing System (CSPro) version 7.3 and Statistical Package for Social Science (SPSS) version 25.0. Descriptive statistic was used to estimate the indicators. Results. Of the 113 patients enrolled, 105 had a history of drug use; 56 participants (53, 3%) had taken at least 2 antibiotics prior to sampling. Cephalosporins were the most consumed antibiotics (41, 0%), followed by nitroimidazols (28, 6%) and penicillins (28,6%). According to the WHO classification, 55 (52, 4%) took the major priority antibiotics. Conclusion. We are on the alert and there is an urging need to raise awareness among clinicians and patients alike by providing them with good clinical practice guidelines.

Problemas na cultura de segurança do paciente em uma unidade de pronto atendimento: análise causal / Problemas en la cultura de seguridad del paciente en una unidad de emergencia: análisis de la cadena causal / Problems in the patient safety culture in an emergency care unit: causal analysis

Objetivo: construir uma matriz de análise para identificação dos problemas relacionados à cultura de segurança do paciente em uma unidade de pronto atendimento no sul do Brasil. Método: a primeira etapa, com delineamento transversal descritivo, ocorreu de julho a agosto de 2018, com enfermeiros, por meio da autoaplicação do instrumento "Safety Attitudes Questionaire - SAQ Short Form 2006". Na segunda etapa, com delineamento exploratório descritivo, as questões do SAQ passaram por análise interpretativa, realizada por enfermeiras dedicadas ao estudo da temática, em abril de 2021. Resultados: os problemas na cultura de segurança do paciente na unidade de pronto atendimento relacionaram-se à estrutura, processos de gestão e processos clínicos, principalmente de caráter organizacional. Conclusão: a utilização da análise de cadeia causal permitiu a construção de uma matriz de análise, facilitando a identificação dos principais problemas relacionados à cultura de segurança do paciente na unidade de pronto atendimento.

Objetivo: to develop an analysis matrix to identify problems related to the patient safety culture in an emergency care unit in southern Brazil. Método: the first stage, with a descriptive cross-sectional design, occurred from July to August 2018, with nurses, through the self-application of the instrument "Safety Attitudes Questionaire - SAQ Short Form 2006". In the second stage, with a descriptive exploratory design, the SAQ questions underwent an interpretative analysis, carried out by nurses dedicated to the study of the subject, in April 2021. Resultados: the problems in the patient safety culture in the emergency care unit were related to the structure, management processes and clinical processes, mainly of an organizational nature. Conclusión: the use of causal chain analysis allowed the construction of an analysis matrix, facilitating the identification of the main problems related to the patient safety culture in the emergency care unit.

Objective: to evaluate the clinical predictors for dry eye and the nursing diagnosis Risk of dry eye in postoperative patients in the Post-Anesthesia Care Unit. Method: cross-sectional study conducted between May and August, 2017. The sample was 157 adult patients undergoing elective surgical procedures. Data were analyzed using descriptive and inferential statistics. Results: the clinical diagnosis of dry eye prevailed in 85.35% of patients, and the nursing diagnosis Risk of dry eye in 14.65%. Statistical differences were observed between hyperemia, excessive tearing and insufficient Schirmer test with the diagnosis of ocular dryness in the right eye and with the diagnosis Risk of dry eye. In the left eye the Schirmer test was insufficient. Conclusão: hyperemia, excessive tearing and insufficient Schirmer test are relevant perioperative clinical predictors to promote preventive measures and/or early detection of dry eye.

Quality improvement in the implementation science paradigm in professional programs: scoping review / Mejora de la calidad en el paradigma de la ciencia de la implementación en programas profesionales: revisión del alcance / Melhoria de qualidade no paradigma da ciência da implementação em programas profissionais: revisão de escopo

ABSTRACT Objective: To map knowledge regarding Quality Improvement in the implementation science paradigm in graduate nursing education in professional programs. Method: This is a scoping review, conducted from October to December 2021, following the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR protocol. Results: 18 studies were selected. Being, 7 articles (38.8%) about the implementation strategies and development of Quality Improvement projects for graduate nursing students. The included studies emphasize Quality Improvement as a methodological strategy capable of capturing a problem in practice, to be solved without losing scientific rigor, and emphasize the importance of obtaining Quality Improvement skills in professional programs. Conclusion: Implementation science and Quality Improvement projects advance professional programs to improve and develop quality health care.

RESUMEN Objetivo: Mapear el conocimiento sobre Mejora de la Calidad en el paradigma de la ciencia de la implementación, en la formación de posgrado en enfermería en programas profesionales. Método: Se trata de una revisión de alcance, realizada de octubre a diciembre de 2021, siguiendo los supuestos establecidos por el Instituto Joanna Briggs y el protocolo PRISMA-ScR. Resultados: Se seleccionaron 18 estudios. Siendo, 7 artículos (38,8%) sobre las estrategias de implementación y desarrollo de proyectos de Mejora de la Calidad para estudiantes de posgrado en enfermería. Los estudios incluidos enfatizan la Mejora de la Calidad como una estrategia metodológica capaz de capturar un problema en la práctica, para ser resuelto sin perder el rigor científico, y resaltan la importancia de obtener habilidades de Mejora de la Calidad en los programas profesionales. Conclusión: La ciencia de la implementación y los proyectos de mejora de la calidad avanzan en los programas profesionales para mejorar y desarrollar una atención médica de calidad.

RESUMO Objetivo: Mapear o conhecimento referente a Melhoria de Qualidade no paradigma da ciência da implementação na educação de pós-graduação em enfermagem de programas profissionais. Método: Trata-se de revisão de escopo, realizada de outubro a dezembro de 2021, seguindo os pressupostos estabelecidos pelo Joanna Briggs Institute e pelo protocolo PRISMA-ScR. Resultados: Foram selecionados 18 estudos. Sendo, 7 artigos (38,8 %) sobre as estratégias de implementação e de desenvolvimento de projetos de Melhoria de Qualidade para estudantes de pós-graduação em enfermagem.Os estudos incluídos fazem ênfase à Melhoria de Qualidade como estratégia metodológica capaz de captar uma problemática da prática, a ser resolvida sem perder o rigor científico e destaca a importância de obter habilidades de Melhoria de Qualidade nos programas profissionais. Conclusão: A ciência da implementação e os projetos de Melhoria da Qualidade avançam nos programas profissionais, para aprimorar e desenvolver os cuidados de saúde com qualidade.

An initiative to improve mental health practice in primary care in Caribbean countries / Una iniciativa para mejorar la práctica de la salud mental en la atención primaria en los países del Caribe / Uma iniciativa para melhorar a atenção primária em saúde mental nos países caribenhos

ABSTRACT Objectives. The aim of this initiative was to assess whether a novel training program - Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills - could improve primary health care providers' confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do-Study-Act rapid cycle for learning improvement. Methods. We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers' confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. Results. A total of 81 participants completed the program. The program improved primary care providers' confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers' stigmatization of people with mental health disorders. Conclusions. The program's quality improvement model achieved its goals in enhancing health care providers' confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.

RESUMEN Objetivos. La finalidad de esta iniciativa fue determinar si un nuevo programa de capacitación, titulado Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills (Comprender la estigmatización y fortalecer las competencias interpersonales cognitivas y conductuales), podría mejorar la confianza de los prestadores de atención primaria de salud en la calidad de la atención de salud mental que proporcionan en los países del Caribe, mediante el uso del ciclo rápido Planificación-Realización-Estudio-Acción para la mejora del aprendizaje. Métodos. Realizamos un estudio de observación prospectivo sobre el impacto de este programa de capacitación. La formación se perfeccionó a lo largo de tres ciclos: en primer lugar, se evaluó la pertinencia del programa para la mejora de las prácticas en el Caribe; en segundo lugar, se llevó a cabo una capacitación piloto de 15 prestadores locales para adaptar el programa a la cultura y el contexto; en tercer lugar, en el otoño del 2021 se puso en marcha el curso con 96 prestadores de atención primaria. Los resultados anteriores y posteriores al programa se evaluaron mediante encuestas que incluían la confianza de los prestadores en la calidad de la atención de salud mental que proporcionaban, los cambios aparecidos en los prestadores en cuanto a la estigmatización, y su uso y conocimiento de las herramientas. En este artículo se describe una evaluación de los resultados del ciclo 3, correspondiente a la puesta en marcha oficial. Resultados. Un total de 81 participantes completaron el programa. El programa mejoró la confianza de los prestadores de atención primaria en la calidad de la atención de salud mental que proporcionaban a las personas que presentaban trastornos de la salud mental y redujo la estigmatización de las personas con este tipo de trastornos por parte de los prestadores de la atención. Conclusiones. El modelo de mejora de la calidad del programa logró sus objetivos en cuanto a mejorar la confianza de los prestadores de atención de salud en la calidad de la atención de salud mental que proporcionan en los países del Caribe; el programa aporta herramientas eficaces para sustentar esta tarea y ayudó a empoderar e involucrar a las personas usuarias.

RESUMO Objetivos. O objetivo da iniciativa foi avaliar se um novo programa de capacitação, Compreensão do estigma e fortalecimento das competências cognitivas e comportamentais interpessoais, seria capaz de aumentar a confiança dos profissionais de atenção primária à saúde na qualidade da atenção à saúde mental que oferecem a pacientes no Caribe, utilizando o ciclo rápido Plan-Do-Study-Act (planejar, fazer, avaliar e agir) para melhorar o aprendizado. Métodos. Este foi um estudo observacional prospectivo sobre o impacto desse programa de capacitação. A capacitação foi aperfeiçoada ao longo de três ciclos. Inicialmente, avaliou-se a relevância do programa para o aprimoramento da prática no Caribe. A seguir, foi realizada uma capacitação-piloto de 15 profissionais locais para adaptar o programa à cultura e ao contexto. No terceiro ciclo, realizado no outono de 2021, o curso foi lançado, com a participação de 96 profissionais de atenção primária. Os resultados antes e depois do programa foram avaliados por meio de questionários, que incluíam a confiança dos provedores na qualidade da atenção à saúde mental oferecida, mudanças no estigma entre os profissionais e a utilização das ferramentas e o conforto dos profissionais em usá-las. Este documento apresenta a avaliação dos resultados do ciclo 3, o lançamento oficial do curso. Resultados. Oitenta e um participantes completaram o programa. O programa melhorou a confiança dos profissionais de atenção primária na qualidade dos cuidados de saúde mental que ofereciam às pessoas com experiência vivida relacionada a problemas de saúde mental. Além disso, reduziu a estigmatização das pessoas com problemas de saúde mental pelos profissionais de saúde. Conclusão. O modelo de melhoria da qualidade do programa atingiu suas metas de aumentar a confiança dos prestadores de serviços de saúde na qualidade dos serviços de saúde mental que prestavam no Caribe; o programa fornece ferramentas efetivas de apoio ao trabalho e ajudou a empoderar e envolver os clientes.

The influence of institutional pancreaticoduodenectomy volume on short-term outcomes in the Brazilian public health system: 2008-2021 / A influência do volume institucional de duodenopancreatectomia nos resultados de curto prazo no sistema público de saúde brasileiro: 2008-2021

ABSTRACT Introduction: pancreaticoduodenectomy is a complex surgical procedure that can result in high rates of complications and morbimortality. Due to its complexity, the establishment of referral centers has increased in recent decades. This study aims to evaluate the influence of the institutional volume of pancreaticoduodenectomy for periampullary cancer on short-term outcomes in the Brazilian public health system. Methods: this study used a population-based approach and investigated the number of pancreaticoduodenectomies performed by institutions within Brazil's public health system between 2008 and 2021. High-volume institutions were defined as those that performed more than two standard deviations above the mean number of procedures per year. Specifically, if a center performed eight or more pancreaticoduodenectomies annually, it was considered a high-volume institution. Results: in Brazil, 283 public hospitals performed pancreaticoduodenectomy for cancer between 2008 and 2021. Only ten hospitals performed at least eight pancreaticoduodenectomies per year, accounting for approximately 3.5% of the institutions. High-volume institutions had a significantly lower in-hospital mortality rate than low-volume institutions (8 vs. 17%). No significant differences between groups were observed for length of stay, hospitalizations using the ICU, and ICU length of stay. The linear regression model showed that the number of hospital admissions for pancreaticoduodenectomy and age were significantly associated with hospital mortality. Conclusion: institutional pancreaticoduodenectomy volume implies a lowering of in-hospital mortality. The findings of this nationwide study can affect how the public health system manages pancreaticoduodenectomy care.

RESUMO Introdução: a duodenopancreatectomia é um procedimento complexo com alta risco de complicações e morbimortalidade. Devido à sua complexidade, a constituição de centros de referência tem aumentado nas últimas décadas. Este estudo tem como objetivo avaliar a influência do volume institucional de duodenopancreatectomia para câncer periampular em resultados de curto prazo no sistema público de saúde brasileiro. Métodos: este estudo utilizou uma abordagem de base populacional e investigou o número de duodenopancreatectomia realizadas por instituições do sistema público de saúde do Brasil entre 2008 e 2021. Definimos instituições de alto volume como aquelas que realizaram mais de dois desvios padrão acima do número médio de procedimentos por ano. Especificamente, um centro seria considerado de alto volume se realizasse oito ou mais duodenopancreatectomias anualmente. Resultados: no Brasil, 283 hospitais públicos realizaram duodenopancreatectomia por câncer entre 2008-2021. Apenas dez hospitais realizaram pelo menos oito duodenopancreatectomias anualmente, correspondendo a aproximadamente 3,5% das instituições. As instituições de alto volume tiveram uma taxa de mortalidade intra-hospitalar significativamente menor do que as instituições de baixo volume (8 vs. 17%). Não foram observadas diferenças significativas entre os grupos quanto ao tempo de internação, internações na UTI e tempo de internação na UTI. O modelo de regressão linear mostrou que o número de internações para duodenopancreatectomia e a idade estiveram significativamente associados à mortalidade hospitalar. Conclusão: o volume institucional da duodenopancreatectomia implica em diminuição da mortalidade intra-hospitalar. Os achados deste estudo nacional podem afetar a forma como o sistema público de saúde gerencia os cuidados com a duodenopancreatectomia..

Process of implementing thirst management in surgical burned patients, based on knowledge translation / Proceso de implementación del manejo de la sed en pacientes quirúrgicos con quemaduras, sobre la base de knowledge translation / Processo de implantação do manejo da sede no paciente queimado cirúrgico embasado no knowledge translation

ABSTRACT Objective: to report the path taken to implement the Thirst Management Model using the Knowledge Translation Evidence-based Practice for Improving Quality intervention in a Burn unit. Method: an experience report on the implementation, which took place in two stages: Preparation; and Implementation/Change, both requiring a sequence of steps. Results: the implementation was performed in four cycles of the PDSA improvement tool. All had the same indicator collected, with increasing goals to be attained. Considering the barriers identified, multiple combined Knowledge Translation strategies were used, namely: posters; theoretical and practical training sessions, individual or in group; videos; dynamics; music; logo development for implementation visibility; audit and feedback; and didactic and illustrated clinical protocols. Conclusion: the report of the entire implementation process using the Evidence-based Practice for Improving Quality intervention, pointing out its weaknesses and strengths, proves to be useful, necessary and innovative. This study may assist in future evidence-based implementations that choose to use multifaceted interventions.

RESUMEN Objetivo: informar el camino recorrido para implementar el Modelo de Manejo de la Sed recurriendo a la intervención Knowledge Translation llamada Evidence-based Practice for Improving Quality (Práctica Basada en Evidencia para Mejorar la Calidad) en una unidad especializada en Quemaduras. Método: informe de experiencia sobre la implementación, que tuvo lugar en dos etapas: Preparación e Implantación/cambio, ambas obedeciendo una secuencia de pasos para su realización. Resultados: la implementación se realizó en cuatro ciclos de la herramienta de mejoras PDSA. En todos los ciclos se recolectó el mismo indicador, con metas crecientes por alcanzar. Considerando las barreras identificadas, se utilizaron múltiples estrategias combinadas de Knowledge Translation, a saber: posters; sesiones de capacitación teóricas y prácticas, individuales o en grupo, videos, dinámicas, música, desarrollo de un logotipo para conferir visibilidad a la implementación; auditoría y feedback; y protocolos clínicos didácticos e ilustrados. Conclusión: el informe de la totalidad del proceso de implementación recurriendo a la intervención Evidence-based Practice for Improving Quality, incluso señalando sus debilidades y puntos fuertes, demuestra que es útil, necesaria e innovadora. Este estudio pode auxiliar futuras implementaciones de evidencias que decidan utilizar intervenciones multifacéticas.

RESUMO Objetivo: Relatar o caminho percorrido para a implantação do Modelo de Manejo da Sede com o uso da intervenção de Knowledge Translation Evidence-based Practice for Improving Quality (Prática Baseada em Evidência para a Melhoria do Processo de Qualidade) em uma unidade de queimados. Método: Relato de experiência sobre a implantação que ocorreu em duas etapas: Preparação e Implantação/ mudança, ambas obedecendo uma sequência de passos para sua realização. Resultados: A implementação foi realizada em quatro ciclos da ferramenta de melhoria PDSA. Todos tiveram o mesmo indicador coletado, com metas crescentes a serem alcançadas. Considerando as barreiras identificadas, utilizaram-se múltiplas estratégias combinadas de Knowledge Translation: cartazes, capacitações teóricas e práticas, individuais ou em grupo, vídeos, dinâmicas, músicas, desenvolvimento de logo para visibilidade da implantação, auditoria e feedback, protocolos clínicos didáticos e ilustrados. Conclusão: O relato de todo o processo de implantação com o uso da intervenção Evidence-based Practice for Improving Quality, apontando suas fragilidades e fortalezas, mostra-se útil, necessária e inovador. Este estudo pode auxiliar futuras implantações de evidências que escolham utilizar intervenções multifacetadas.

Notificação de incidentes e a segurança do paciente em tempos de pandemia / Notificación de incidentes y la seguridad del paciente en tiempos de pandemia / Incident notification and patient safety in times of a pandemic

Resumo Objetivo Analisar as notificações de incidentes ocorridos durante a pandemia de COVID-19. Métodos Estudo com delineamento transversal de abordagem quantitativa do tipo descritivo exploratório. Foram analisadas 1.466 notificações à gerência de risco de um hospital privado, no período de setembro de 2020 a setembro de 2021. Utilizou-se a análise estatística descritiva, aplicando o teste Qui-quadrado de Pearson ou o teste da Razão de Verossimilhança. A margem de erro utilizada foi de 5%. Resultados Identificou-se como incidentes prevalentes a falha na comunicação (358 - 24,5%), falha no uso de sondas e cateteres (232 - 15,9%) e falha no uso de artigos e equipamentos (132 - 9,1%). A circunstância notificável totalizou (55,9%) dos relatos e destas, (33,4%) eram falha na comunicação. Os eventos adversos foram em número de 416 (28,6%) e a queda esteve relacionada a dano leve (43,9%); Infecção relacionada à assistência à saúde ao dano moderado (31%) e a falha no uso de medicamentos a (50%) como dano grave e óbito. Conclusão Falha na comunicação foi a circunstância de risco mais notificada, seguida de falha no uso de medicamentos como evento adverso com dano grave. A unidade de enfermaria evidenciou a possibilidade de maior número de eventos adversos; enquanto que nas unidades de terapia intensiva o grau de dano dos eventos adversos foi superior.

Resumen Objetivo Analizar las notificaciones de incidentes ocurridos durante la pandemia de COVID-19. Métodos Estudio con diseño transversal de enfoque cuantitativo del tipo descriptivo exploratorio. Se analizaron 1.466 notificaciones de la gestión de riesgo de un hospital privado, en el período de septiembre de 2020 a septiembre de 2021. Se utilizó el análisis estadístico descriptivo, aplicando la prueba χ2 de Pearson o la prueba de razón de verosimilitud. El margen de error utilizado fue del 5 %. Resultados Se identificaron como incidentes prevalentes la falla en la comunicación (358 - 24,5 %), falla en el uso de sondas y de catéteres (232 - 15,9 %) y falla en el uso de artículos y equipos (132 - 9,1 %). Las circunstancias que pueden ser notificadas totalizaron (55,9 %) de los relatos y, entre ellas, (33,4 %) era una falla en la comunicación. Los eventos adversos totalizaron 416 (28,6 %) y la disminución estuvo relacionada con el daño leve (43,9 %); infección relacionada con la atención a la salud al daño moderado (31 %) y a la falla al usar medicamentos (50 %) como daño grave y defunción. Conclusión La falla en la comunicación fue la circunstancia de riesgo más notificada, seguida de falla al usar medicamentos como evento adverso con daño grave. La unidad de enfermería evidenció la posibilidad de un número más elevado de eventos adversos; mientras que en las unidades de terapia intensiva el grado de daño de los eventos adversos fue superior.

Abstract Objective To review notification of incidents that occurred during the COVID-19 pandemic. Methods This is a cross-sectional, exploratory descriptive quantitative study. A total of 1,466 notifications to risk management of a private hospital were analyzed from September 2020 to September 2021. Descriptive statistical analysis was used, applying Pearson's chi-square test or the likelihood ratio test. The margin of error used was 5%. Results Communication failure (358 - 24.5%), probe and catheter use failure (232 - 15.9%) and article and equipment use failure (132 - 9.1%) were identified as prevalent incidents. The notifiable circumstance totaled 55.9% of reports, and, of these, 33.4% were communication failure. Adverse events were 416 (28.6%), and fall was related to mild damage (43.9%), health care-associated infections, to moderate harm (31%), and medication use failure (50%), to severe harm and death. Conclusion Communication failure was the most reported risk circumstance, followed by medication use failure as an adverse event with severe harm. The nursing unit showed the possibility of a greater number of adverse events, while in Intensive Care Units, the degree of harm from adverse events was higher.

Estatísticas Cardiovasculares do Programa Boas Práticas em Cardiologia - Dados de um Hospital Público Terciário Brasileiro / Cardiovascular Statistics from the Good Practices in Cardiology Program - Data from a Brazilian Tertiary Public Hospital

Resumo Fundamento O Programa Boas Práticas em Cardiologia é uma iniciativa da Sociedade Brasileira de Cardiologia (SBC) destinada à melhoria do cuidado cardiovascular nos hospitais públicos brasileiros. Objetivos Descrever características dos pacientes internados com Síndrome Coronariana Aguda (SCA) e Insuficiência Cardíaca (IC) e avaliar os indicadores de desempenho alcançados nos braços (SCA e IC) em um hospital público terciário, com uma meta pré-estabelecida de 85% de aderência às recomendações da SBC. Métodos Estudo do tipo transversal descritivo realizado por meio da coleta de dados de pacientes que estiveram internados entre maio de 2016 e setembro de 2019. Resultados Foram incluídos 1036 pacientes, 273 pacientes no braço IC e 763 no braço SCA. A média de idade foi de 59,8 ± 12,0 anos na SCA e 57,0 ± 14,1 anos na IC, com predomínio do sexo masculino em ambos os grupos. Mais da metade dos pacientes não tinham ensino fundamental completo e mais de 90% declararam renda mensal inferior a cinco salários-mínimos. Na SCA, predominou o diagnóstico de SCA com supradesnivelamento do segmento ST (66,3%) e 2,9% dos pacientes foram a óbito. Na IC, a etiologia mais comum foi a Doença de Chagas (25,8%) e 17,9% dos pacientes foram a óbito. Na avaliação dos indicadores de desempenho, nove dos 12 indicadores tiveram taxas de aderência acima de 85%. Conclusão Programas de qualidade são essenciais à melhoria do cuidado e os indicadores de desempenho do hospital apontam para uma boa adesão às diretrizes assistenciais da SBC, particularmente no braço da SCA.

Abstract Background The Good Practices in Cardiology Program is an initiative created by the Brazilian Society of Cardiology (SBC) to improve the quality of care of cardiovascular disease patients in Brazilian public hospitals. Objectives To characterize patients admitted to a tertiary public hospital with diagnosis of acute coronary syndrome (ACS) or heart failure (HF) and to evaluate performance indicators in both ACS and HF arms, with a pre-established target of 85% adherence to the SBC recommendations. Methods This was a descriptive cross-sectional study through data collection of patients hospitalized between May 2016 and September 2019. Results A total of 1,036 patients were included, 273 in the HF arm and 763 in the ACS arm. Mean age was 59.8 ± 12.0 years in the ACS and 57.0 ± 14.1 years in the HF, with a predominance of male patients in both groups. More than half of patients had some primary education and more than 90% reported a monthly income of less than five minimum wages. In ACS, the diagnosis of ACS with ST segment elevation was predominant (66.3%), and 2.9% of patients died. In HF, the most common etiology was Chagas disease (25.8%), and 17.9% died. Analysis of the performance indicators revealed an adherence rate higher than 85% to nine of the 12 indicators. Conclusion Quality programs are essential for improvement of quality of care. Performance indicators pointed to a good adherence to the SBC guidelines, mainly in the ACS arm.

Construction of foreign medical quality and safety management models based on qualitative text analysis / 中华医院管理杂志

Objective:To systematically construct the foreign medical quality and safety management model by searching the English literature related to medical quality and safety management, so as to provide reference for improving the level of medical quality and safety management in China.Methods:The Web of Science database was used as the data source, the English literature related to medical quality and safety management in foreign countries was screened following the PRISMA guidelines, and the content of the screened literature was analyzed using qualitative text analysis based on the Structure Process System Outcome (SPSO) theoretical model.Results:In this study, a total of 37 articles were screened, 5 first-level themes of structure, process, system, outcome and continuous quality improvement were identified, 16 second-level themes were found, and their functional relationships were established. A theoretical model of the SPSO-Extension (SPSO-E) for medical quality and safety management was constructed, added new elements of the external environment, organizational outcome and employee outcome, and refined the continuous quality improvement into three segments of quality checking, problem handling and quality consolidation.Conclusions:In order to improve medical quality and safety management in China, the internal management model of the hospital should be dynamically adjusted according to the changes of external environment, and the result dimension should pay attention to the improvement of organization′s operational effectiveness and the physiological and psychological aspects of the staff. The final management results have a feedback effect on the hospital′s resource allocation, service delivery, organizational arrangements and cultural construction, promoting continuous improvement and enhancement of the hospital′s quality.

Promotion and application of clinical microbiology related standards and guidelines in clinical practice / 中华检验医学杂志

Under the circumstances of the rapid development of etiological diagnostic technology and the increasing application of new testing technologies to microbial detection, laboratory workers and clinical related departments should promptly propose Chinese standards, Chinese guidelines, and Chinese diagrams, and always adhere to the promotion and application of clinical microbiology related standards and guidelines in clinical practice, to continue to promote the virtuous cycle of standardization of etiology diagnosis, and gradually improve the laboratory diagnosis ability and technological progress of infectious diseases in China.

Application of PDCA cycle in quality improvement of neonatal resuscitation / 中国新生儿科杂志

Objective:To study the effects of plan-do-check-action (PDCA) cycle in quality improvement of neonatal resuscitation.Methods:From 2016 to 2020, the clinical data of neonates born in our hospital were analyzed. Neonates born during 2016 to 2017 were pre-PDCA group and neonates born during 2018 to 2020 were post-PDCA group. PDCA quality improvement included step-by-step, high-frequency and low-dose training, strengthening teamwork and adding equipment.Results:A total of 7 728 live-birth neonates were delivered before PDCA with 319 cases (4.1%) of asphyxia. 10 174 live-birth neonates were delivered after PDCA with 422 cases (4.1%) of asphyxia. The asphyxia rates showed no significant difference between the two groups ( P>0.05). The incidences of severe asphyxia before and after PDCA were both 0.8% without significant difference ( P>0.05). The success rates of resuscitation for severe asphyxia before and after PDCA was 27.9% and 44.9%, respectively, and the differences were statistically significant ( P<0.05). The mortality rates within 7 d before and after PDCA were 0.5‰ and 0.1‰ respectively, without significant differences ( P>0.05). Conclusions:The implementation of PDCA cycle and step-by-step, high-frequency, low-dose neonatal resuscitation training can effectively improve the success rate of resuscitation in newborns with severe asphyxia.

The effect of the quality improvement project of admission hypothermia on short-term outcomes of preterm infants less than 34 weeks gestational age / 中国小儿急救医学

Objective:To study the high risk factors of hypothermia in premature infants with gestational age ≤34 weeks, and to analyze the incidence of hypothermia before and after the implementation of the quality improvement program of hypothermia in hospital and its influence on various systemic complications, aiming to improve the early identification of hypothermia and to reveal the important clinical significance of temperature management in time.Methods:Clinical data of preterm infants born in Maternal and Child Health Hospital of Hubei Province from May 2017 to December 2018, with gestational age ≤34 weeks, and admitted within 1 hour after birth were collected.According to the admission temperature, the infants were divided into normal temperature group (36.5-37.5 ℃), mild hypothermia group (36.0-36.4 ℃), moderate hypothermia gsroup (32.0-35.9 ℃), and severe hypothermia group (<32.0 ℃). The high risk factors of hypothermia in premature infants were analyzed.The incidence and degree of hypothermia and the effects on the systemic complications before and after the implementation of the hypothermia quality improvement program were compared.Results:A total of 306 premature infants were enrolled in the study, including 63(20.6%)cases in the normal temperature group, 115(37.6%) cases in the mild hypothermia group, and 128(41.8%) cases in the moderate hypothermia group, without severe hypothermia.Infants with birth asphyxia were at higher risk for hypothermia( OR=0.195, 95% CI 0.046-0.833, P=0.027); the lower the Apgar score at 1 min( r=0.123, P=0.032)and 5 min after birth( r=0.136, P=0.017), the higher the risk of admission hypothermia.After the quality improvement project, the incidence of admission hypothermia decreased from 82.3% to 73.8%( χ2=32.67, P<0.001), and the use of pulmonary surfactant in infants with respiratory distress syndrome was significantly reduced(70.0% vs. 32.0%, χ2=40.11, P<0.001), and the incidence of hypotension within 72 hours after birth decreased(11.8% vs. 4.9%, χ2=3.87, P<0.049). Conclusion:Birth asphyxia is a risk factor for admission hypothermia in premature infants, and Apgar score is associated with admission hypothermia in premature infants.Temperature management of preterm infants can significantly reduce the incidence of hypothermia and hypotension, and reduce the use of pulmonary surfactant in respiratory distress syndrome infants.

Research on quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy / 中国实用护理杂志

Objective:To explore the effect of quality improvement based on action research study to reduce unplanned interruption during continuous renal replacement therapy.Methods:From June 2020 to December 2021, 175 patients who were treated CRRT in SICU of Beijing Chaoyang Hospital Affiliated to Capital Medical University were selected as research objects. The objects were divided into control group, observation group 1 and observation group 2 according to the time of admission. Routine nursing was used in the control group (55 cases), the first cycle of plan-action-observation-reflection according to the problems of unplanned interruption was used in the observation group 1(62 cases), the quality improvement was carried out on the basis of the first cycle, and then formulated the second cycle used in the observation group 2(58 cases). The incidence of unplanned interruption of CRRT, the duration of hemofiltration line and the ability of nurses to prevent unplanned interruption of CRRT were compared before and after implementation.Results:The baseline data of CRRT patients in the three groups were comparable ( P>0.05). After cycle quality improvement, the alarm frequencies of unplanned interruption in the observation group 1 and 2 was (8.87 ± 2.66) times and (8.07 ± 2.80) times respectively, which was significant lower than the (12.04 ± 4.23) times in the control group ( t = 3.17 and 3.97, both P<0.01). The cases of coagulation filter≥Ⅱ in the observation group 1 and 2 were 25 cases and 20 cases, which were significant lower than the 32 cases in the control group ( χ2 = 3.72, 6.38, both P<0.05). The duration of blood purification line use was (15.04 ± 7.51) h and (18.16 ± 7.67) h in the observation group 1 and 2, which were significant better than the (11.75 ± 6.84) h in the control group ( t = 3.29 and 6.41, both P<0.01). The ability of nurse to prevent unplanned interruption of CRRT in the control group, the observation group 1 and 2 were (72.62 ± 6.03), (84.77 ± 5.59) and (89.64 ± 4.54), the difference was sigaificant ( F = 146.97, P<0.001). Conclusions:The application of action research study in CRRT quality improvement could reduce the occurrence of unplanned interruption of CRRT and related complications, prolong the use time of hemofiltration line, improve the therapeutic effect of CRRT, improve the quality of nursing, and is worthy of clinical promotion.

Door-to-needle time for intravenous thrombolysis in acute ischemic stroke / 国际脑血管病杂志

Intravenous thrombolysis is an effective treatment for acute ischemic stroke, but its benefits are time-dependent. The time from onset to intravenous thrombolysis is divided into onset-to-door time (ODT) and door-to-needle time (DNT). The former reflects pre-hospital delay, while the latter reflects in-hospital delay and can be controlled by stroke improvement plan. This article reviews the influence of DNT on clinical outcomes, the influencing factors of DNT and the stroke improvement plan to shorten DNT.