[Using TRM to Enhance the Accuracy of Ventilator-Associated Pneumonia Preventive Measures Implemented by Neonatal Intensive Care Unit Medical Staffs].

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. PURPOSE: To improve the accuracy of implementation of preventive measures for VAP among medical staffs and reduce the density of VAP infections in the NICU. RESOLUTIONS: Conduct a literature search and adopt medical team resources management methods; establish effective team communication; establish monitoring mechanisms and incentives; establish mandatory in-service specialization education contents and a VAP preventive care guide exclusively for newborns as a reference for medical staffs during care execution; install additional equipment and aids and set reminders to ensure the implementation of VAP preventive measures. RESULTS: The accuracy rate of preventive measure execution by medical staffs improved from 70.1% to 97.9% and the VAP infection density in the NICU decreased from 4.7‰ to 0.52‰. CONCLUSIONS: Team integration effectively improved the accuracy of implementation of VAP-prevention measures, reduced the density of VAP infections, enhanced quality of care, and ensured that newborns received care that was more in line with specialization needs.

[Practical strategies to improve communications with school-aged children in the PICU].

BACKGROUND & PROBLEMS: Children in the PICU who are treated for illnesses using intubation are often unable to express their needs effectively. This project first used a self-designed survey to record the researcher's observations and interview data. Results indicated that even with clinical staffs trying their best to understand PICU patient needs, 50% of the patients had unmet demands due to inadequate communication. This unmet demand was a source of negative patient behavior. PURPOSE: This project developed an appropriate communication system to improve communication efficacy between children and clinical staffs in order to meet patient demands and improve PICU patient outcomes. RESOLUTION: Various types of auxiliary school-aged-children-appropriate communication tools such as picture cards, hand-held communication boards, and magnetic spelling board were used. Using these communication tools together with education and training greatly improved communication efficacy and patient needs provision. RESULTS: Percentage of patient needs met increased from 50% to 98% and the average time clinical staffs needed to spend to understand a patient's needs decreased from 15 to 4 minutes per instance. CONCLUSIONS: This project improved relationships and interactions between clinical nurses and school-aged children. The developed auxiliary communication tools may be introduced in the PICU based on the results of this project as an effective approach to improving patient-staff communication and reducing patient-perceived hospitalization stress.