山东省孕妇死亡检测产科出血死亡177例分析

目的　探讨 10 a来孕产妇死亡中产科出血发生的原因及预防措施。方法　对全省 16个监测点 10 a孕产妇死亡中产科出血 177例进行了回顾性分析。结果　 10 a孕产妇死亡中产科出血占孕产妇死亡的 4 3.9% ,而宫缩乏力仍是产科出血的首要原因。结论　提高住院分娩率是减少孕产妇死亡的首要措施 ,加强医疗保健人员的业务培训 ,提高其知识技能 ,是降低孕产妇死亡中产科出血的关键。     

Implementing a Statewide Speakers Bureau to Address Maternal Morbidity and Mortality

ObjectiveTo implement a speakers bureau to educate providers, health caregivers, and staff practicing within Tennessee hospitals on evidence-based practice recommendations related to opioid use disorder in pregnancy, postpartum hemorrhage, maternal hypertension, and implicit bias.DesignQuality improvement project.Setting/Local ProblemMultiple health care facilities throughout Tennessee, where rates of pregnancy-related mortality are greater than the national average and where Black women are three times as likely as White women to die of pregnancy complications.ParticipantsSpeakers (n = 47) included obstetricians, advanced practice providers, and nurses. Program attendees (n = 369) included providers and caregivers representing five health care facilities.Intervention/MeasurementsSpeakers were provided standardized training to disseminate best practice methods. Current evidence-based presentations regarding the top maternal mortality concerns were formatted for educational events at five Tennessee health care facilities. Independent outcome measures using electronic survey instruments were collected for speakers and audience participants. Speakers evaluated training methods, and participants evaluated the quality and efficacy of the information provided.ResultsBased on speaker evaluations, 70.59% rated the quality of training as 5 of 5, and 76.47% rated the relevance of training as 5 of 5. Overall, 16 of 17 (94.1%) speakers stated that adequate training was provided. Analysis of participant evaluations reported that 57.5% were very confident (5/5) that the information learned through the speakers bureau will improve their care of pregnant and postpartum people. Additionally, 71% were very likely (5/5) to apply the information to their practice.ConclusionThis project showed the dissemination of best practices by promoting knowledge, supporting practice change, and improving retained information in maternity providers and caregiver participants. Implementation of speakers bureaus to educate providers and caregivers within health care facilities has the potential to influence practice change and decrease maternal morbidity and mortality rates in the state of Tennessee.     

Implementation of paediatric pain care-bundle across South-West England clinical network of Emergency Departments and Minor Injury Units: A before and after study

IntroductionPain management in children is often poorly executed in Emergency Departments and Minor Injury Units. The aim of this study was to assess the impact of a care bundle comprising targeted education on pain score documentation and provision of appropriately dosed analgesia for the paediatric population attending Emergency Departments (EDs) and Minor Injury Units (MIUs).MethodsA total of 29 centres – 5 EDs and 24 MIUs – participated in an intervention study initiated by Emergency Nurse Practitioners to improve paediatric pain management. In Phase 1, up to 50 consecutive records of children under 18 presenting at each MIU and ED were examined (n = 1201 records); Pain Score (PS), age, whether the child was weighed, and provision of analgesia was recorded. A care bundle consisting of an education programme, paediatric dosage chart and flyers, was then introduced across the 29 centres. Nine months following introduction of the care bundle, the same data set was collected from units (Phase 2, n = 1090 records).ResultsThe likelihood of children having a pain score documented increased significantly in Phase 2 (OR 6.90, 95% CI 5.72–8.32), The likelihood of children receiving analgesia also increased (OR1.82, 95% CI 1.51–2.19), although there was no increase in the proportion of children with moderate or severe pain receiving analgesia. More children were weighed following the care bundle (OR 2.58 95% CI 1.86–3.57). Infants and children who were not weighed were more likely to receive an incorrect analgesia dose (p < 0.01).ConclusionsRates of PS documentation improved and there was greater provision of analgesia overall following introduction of the care bundle. Although weighing of children did improve, the levels remain disappointingly low. EDs generally performed better than MIUs. The results show there were some improvements with this care bundle, but future work is needed to determine why pain management continues to fall below expected standards and how to further improve and sustain the impact of the care bundle.     

Three years of preanalytical errors: Quality specifications and improvement through implementation of statistical process control

Abstract

Background: The objectives of this research were to show the most frequent preanalytical sample errors from two distinct patient populations and blood-drawing personnel, to calculate preanalytical quality specifications, and to demonstrate an improvement strategy for patients whose samples have been drawn in the primary health care center by means of a monthly preanalytical quality control report based on statistical process control (SPC). Material and methods: We collected preanalytical errors from the tests requested for hematology, coagulation, chemistry, and urine samples in both populations. To monitor an improvement strategy, we designed a set of indicators. The indicator results for 35 months were entered into the statistical software application, where they were statistically analyzed. The preanalytical quality specifications were calculated using the SPC control charts. The intervention consisted of the sending of a monthly preanalytical quality report to a pilot Decentralized Phlebotomy Center (DPC) and setting up a direct communication channel between the laboratory and the DPC. Results: Fewer errors were observed when the sample drawing was carried out by the laboratory personnel, showing distinct preanalytical quality specifications. Improvements were seen in the DPC after four months of the improvement strategy. Conclusions: We show a practical and effective methodology for the identification, monitoring, and reduction of preanalytical errors using the technology employed in daily total testing laboratory process.     

Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage

Objective

To measure the impact of a progressive mobility program on patients admitted to a neurocritical critical care unit (NCCU) with intracerebral hemorrhage (ICH). The early mobilization of critically ill patients with spontaneous ICH is a challenge owing to the potential for neurologic deterioration and hemodynamic lability in the acute phase of injury. Patients admitted to the intensive care unit have been excluded from randomized trials of early mobilization after stroke.