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新生儿重症监护病房教育计划可有效降低患儿不良事件风险
作者:小柯机器人 发布时间:2022/1/23 17:54:06

法国克雷泰尔社区间医院中心Laurence Caeymaex团队研究了新生儿重症监护病房的教育计划对患儿预后的影响。相关论文于2022年1月22日发表在《柳叶刀》杂志上。

新生儿重症监护病房(NICUs)患儿发生不良事件的风险较高。医疗和辅助医疗教育方案减少这些风险的效果尚未有效评估。

研究组在法国进行了一项多中心、阶梯楔形、群集随机对照试验,将12个NICU随机分配到3个组,每组4个。符合条件的新生儿在NICU住院至少2天,入院时胎龄不超过42周。

每个集群都进行了为期4个月的多方面课程,包括关于根本原因分析和护理包的教育。主要结局是每1000患者-天的不良事件发生率,通过一个基于回顾性触发器工具的图表审查屏蔽至分配随机选择的文件。分析使用了混合效应泊松模型,并根据时间进行了校正。

2015年11月23日至2017年11月2日,研究组对这12个NICU的3454例患者共进行了65830患者-天的分析。对照组每1000患者-天发生33.9起不良事件,干预组每1000患者-天发生22.6起,发病率比为0.67,组间差异显著。

研究结果表明,NICU的多专业安全促进计划降低了高危患者不良事件和严重可预防的不良事件的发生率。该方案可显著改善危重新生儿的临床护理结局。

附:英文原文

Title: An educational programme in neonatal intensive care units (SEPREVEN): a stepped-wedge, cluster-randomised controlled trial

Author: Laurence Caeymaex, Dominique Astruc, Valérie Biran, Leila Marcus, Florence Flamein, Stephane Le Bouedec, Bernard Guillois, Radia Remichi, Faiza Harbi, Xavier Durrmeyer, Florence Casagrande, Nolwenn Le Saché, Darina Todorova, Ali Bilal, Damien Olivier, Audrey Reynaud, Cécile Jacquin, Jean-Christophe Rozé, Richard Layese, Claude Danan, Camille Jung, Fabrice Decobert, Etienne Audureau

Issue&Volume: 2022/01/22

Abstract:

Background

Patients in neonatal intensive care units (NICUs) are at high risk of adverse events. The effects of medical and paramedical education programmes to reduce these have not yet been assessed.

Methods

In this multicentre, stepped-wedge, cluster-randomised controlled trial done in France, we randomly assigned 12 NICUs to three clusters of four units. Eligible neonates were inpatients in a participating unit for at least 2 days, with a postmenstrual age of 42 weeks or less on admission. Each cluster followed a 4-month multifaceted programme including education about root-cause analysis and care bundles. The primary outcome was the rate of adverse events per 1000 patient-days, measured with a retrospective trigger-tool based chart review masked to allocation of randomly selected files. Analyses used mixed-effects Poisson modelling that adjusted for time. This trial is registered with ClinicalTrials.gov, NCT02598609.

Findings

Between Nov 23, 2015, and Nov 2, 2017, event rates were analysed for 3454 patients of these 12 NICUs for 65830 patient-days. The event rate per 1000 patient-days reduced significantly from the control to the intervention period (33·9 vs 22·6; incidence rate ratio 0·67; 95% CI 0·50–0·88; p=0·0048).

Interpretation

A multiprofessional safety-promoting programme in NICUs reduced the rate of adverse events and severe and preventable adverse events in highly vulnerable patients. This programme could significantly improve care offered to critically ill neonates.

DOI: 10.1016/S0140-6736(21)01899-7

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01899-7/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet