PDF(Pubmed)
Abstract：
Optimal cord management (OCM), defined as waiting at least 60 seconds (s) before clamping the umbilical cord after birth, is an evidence-based intervention that improves outcomes for both term and preterm babies. All major resuscitation councils recommend OCM for well newborns.National Neonatal Audit Programme (NNAP) benchmarking data identified our tertiary neonatal unit as a negative outlier with regard to OCM practice with only 12.1% of infants receiving the recommended minimum of 60 s. This inspired a quality improvement project (QIP) to increase OCM rates of ≥ 60 s for infants <34 weeks. A multidisciplinary QIP team (Neonatal medical and nursing staff, Obstetricians, Midwives and Anaesthetic colleagues) was formed, and robust evidence-based quality improvement methodologies employed. Our aim was to increase OCM of ≥ 60 s for infants born at <34 weeks to at least 40%.The percentage of infants <34 weeks receiving OCM increased from 32.4% at baseline (June-September 2022) to 73.6% in the 9 months following QIP commencement (October 2022-June 2023). The intervention period spanned two cohorts of rotational doctors, demonstrating its sustainability. Rates of admission normothermia were maintained following the routine adoption of OCM (89.2% vs 88.5%), which is a complication described by other neonatal units.This project demonstrates the power of a multidisciplinary team approach to embedding an intervention that relies on collaboration between multiple departments. It also highlights the importance of national benchmarking data in allowing departments to focus QIP efforts to achieve long-lasting transformational service improvements.
摘要：
最佳电源线管理(OCM)，定义为在出生后夹紧脐带之前等待至少60秒，是一种基于证据的干预措施，可改善足月和早产儿的预后。所有主要的复苏委员会都建议为新生儿提供OCM。国家新生儿审核计划（NNAP）基准数据将我们的三级新生儿单元确定为OCM实践的负面异常值，仅有12.1％的婴儿接受推荐的最低60s。这激发了一项质量改进项目（QIP），以提高<34周婴儿的OCM率≥60s。一个多学科QIP团队(新生儿医疗和护理人员，产科医生,助产士和麻醉同事）成立，以及采用稳健的基于证据的质量改进方法。我们的目标是将<34周出生的婴儿≥60s的OCM增加到至少40％。<34周接受OCM的婴儿百分比从基线（2022年6月至9月）的32.4％增加到QIP开始后9个月（2022年10月至2023年6月）的73.6％。干预期跨越了两组轮岗医生，展示其可持续性。常规采用OCM后，入院率保持正常体温（89.2％vs88.5％），这是其他新生儿单位描述的并发症。该项目展示了多学科团队方法的力量，以嵌入依赖于多个部门之间协作的干预措施。它还强调了国家基准数据在允许部门集中QIP工作以实现持久的转型服务改进方面的重要性。
