[Using the FOCUS Family Intervention for Family-Centered Care in a Premature Infant With Grade IV Intraventricular Hemorrhage].

Preterm infants face increased rates of mortality and developmental complications, which are a burden on children's parents (and caregivers), who suffer from exhaustion and situational uncertainty. This case focused on an extremely-low-birth-weight (908 gm) premature infant with initial unstable vital signs complicated by a grade 4 intraventricular hemorrhage (IVH) that led to partial brain atrophy and enlarged brain ventricles. A poor neurological outcome was expected due to the high risk of cerebral palsy and impaired cognitive abilities. Long-term healthcare for this critical infant was causing tremendous physical, emotional, and financial strains on the family. The parents suffered from worries over the poor prognosis, resulting in stress, sleep disorders, and relationship difficulties with the healthcare professionals. Considering the poor prognosis of the infant, the parents faced a medical dilemma between choosing aggressive treatment and withdrawal of treatment, which led to stress and sleep disorders. Differences between the parents and health professionals regarding disease severity perception and treatment opinions further strained their mutual relationship. To ameliorate this issue, the author implemented family-centered care (the FOCUS family intervention) to help the patient and his family. This intervention is designed to increase family involvement, foster an optimistic attitude and effective stress coping techniques, and reduce uncertainty and negative emotions. For the patient, we provided symptom-relief management to improve abnormal muscle tone and development delay. Our intervention ameliorated the negative emotions, insomnia symptoms, and imbalanced family relationships and improved the life quality of the caregivers. Furthermore, the intervention enhanced the patient's autoregulatory ability, and both physical and neurological development. This case study is expected to provide experience in critical care for premature infants with a poor prognosis and their family using a FOCUS family intervention as well as to improve the quality of healthcare delivery in intensive clinical settings.

[Quality Improvement Project: Increasing the Rate of Proper Use of Infant Transferring Warmers].

BACKGROUND & PROBLEMS: Infant-transferring warmers provide a warm environment and emergency care facilities such ventilators for high-risk infants during transport. Accurate use of this warmer has been demonstrated to reduce rates of neonatal complications and increase rates of survival. This project found that, despite the complaints of nurses that warmers occasionally malfunctioned during the transfer process, warmer functions nearly always tested normal after use. Therefore, the researchers surveyed ward nurses to better understand the underlying reasons for these complaints. Results found that only 68.4% of those surveyed operated the warmer correctly. The reasons for improper use were analyzed and categorized as: Nurse-related factors - lack of warmer operating knowledge and experience in the clinic; System-related factors - lack of a standard operating procedure (SOP) and monitor/audit practices and an incomplete training protocol; Equipment-related factors - lack of an equipment preparation SOP and difficulties in setting the ventilator properly. PURPOSE: The purpose of this project was to achieve a 100% rate of proper warmer use among nurses. RESOLUTION: Through continuous clinical education, we created a standard operating procedure for warmer operation, created a video and poster for warmer users, simplified the equipment preparation SOP, and periodically monitored and checked results. RESULTS: After the intervention, 100% of the nurses were able to use the warmers correctly. Additionally, the rate of satisfaction for nursing-warmer use among the participating nurses increased from 51.4% to 80.6%. CONCLUSIONS: This project effectively increased the rate for correctly using transferring warmers among participating nurses and improved the quality of medical care.

[Reducing the Unplanned Removal Rate of Endotracheal Tubes in the Pediatric Intensive Care Unit].

BACKGROUND & PROBLEMS: In 2012, the rate of unexpected removal of endotracheal tubes in our pediatric intensive unit was above the maximum target level of 0.28%. We designed a survey to identify the relevant difficulties faced by nurses in order to formulate viable solutions and reduce the removal rate. After assessing the findings of this survey, we concluded that the following represented the primary difficulties: use of incorrect endotracheal tube care standards, the inadequate sedation of patients, the incorrect cognition of care of nurses, and lack of in-service education and securing techniques. PURPOSES: After implementing quality improvements to overcome these difficulties, the rate of unexpected removal dropped dramatically to 0.57%. RESOLUTION: Our quality improvement strategy included: designing a protocol and a checklist for securing endotracheal tubes, purchasing additional waterproof tape and restraint straps, establishing a standard protocol for sedation, producing an educational DVD, and continuing in-service education. RESULTS: After implementation of the above measures, the rate of unexpected removal fell dramatically from 0.76% to 0.33%. Additionally, the completion-of-care rate for patients with endotracheal tubes rose significantly from 27.2% to 94.5%. CONCLUSIONS: This project established a standard procedure for caring for endotracheal tube patients; improved communication among staff members; and reduced unexpected removal events.

[Applying root cause analysis to promote the medication safety of continuous drug infusions for infants].

BACKGROUND & PROBLEMS: An adverse medication event involving a continuous drug infusion dosage error was reported in the infant intensive care unit of our hospital in 2010. The causes of this adverse medication event were elicited in the healthcare network using root cause analysis. These causes included incomplete procedures and incorrect prescription, an incomplete procedure of medication in continuous drug infusion, complex procedures in confirming prescription, the transcription of doctor's orders and prescription (i.e., kardex), and deficient knowledge of medication procedures exhibited by clinical nurses. PURPOSES: The main purpose of this project was to achieve a 100% completion rate for nurse administrations of continuous intravenous medication and zero adverse medication events. RESOLUTIONS: Strategies included simplifying the prescription verification process, establishing regulations for drug prescription, standardizing the steps required for continuous intravenous medication administration, developing the dosage criteria for continuous intravenous medication, and developing a double-check mechanism for high-risk medications. In addition, relevant nurse's continuous educational programs were provided to help nurses effectively implement drug administration. RESULTS: The completion rate for administering the medication steps has increased to 99% and the compliance rate for pediatricians' orders regarding medication prescription has increased to 96%. Furthermore, no additional adverse medication events were observed after the intervention. CONCLUSIONS: This project established a systemic drug administration mechanism to promote communication and cooperation among healthcare teams and further enhanced medication safety and quality for infants.