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Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach.

ABSTRACT: Growth of neonatal intensive care units in number and size has raised questions towards ability to maintain continuity and quality of care. Structural organization of intensive care units is known as a key element for maintaining the quality of care of these fragile patients. The reconstruction of megaunits of intensive care to smaller care units within a single operational service might help with provision of safe and effective care.The clinical team and patient distribution lay out, admission and discharge criteria and interdisciplinary round model was reorganized to follow the microstructure philosophy. A working group met weekly to formulate the implementation planning, to review the adaptation and adjustment process and to ascertain the quality of implementation following the initiation of the microsystem model.In depth examination of microsystem model of care in this study, provides systematic evaluation of this model on variable aspects of health care. The individual projects of this trial can be source of solid evidence for guidance of future decisions on optimized model of care for the critically ill newborns.ClinicalTrial.gov, NCT02912780 . Retrospectively registered on 22 September 2016.

SUBMITTER: El Helou S

PROVIDER: S-EPMC5251231 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach.

El Helou Salhab S Samiee-Zafarghandy Samira S Samiee-Zafarghandy Samira S Fusch Gerhard G Wahab Muzafar Gani Abdul MG Aliberti Lynda L Bakry Ahmad A Barnard Deborah D Doucette Joanne J El Gouhary Enas E Marrin Michael M Meyer Carrie-Lynn CL Mukerji Amit A Nwebube Anne A Pogorzelski David D Pugh Edward E Schattauer Karen K Shah Jay J Shivananda Sandesh S Thomas Sumesh S Twiss Jennifer J Williams Connie C Dutta Sourabh S Fusch Christoph C

BMC health services research 20170121 1

<h4>Background</h4>Growth of neonatal intensive care units in number and size has raised questions towards ability to maintain continuity and quality of care. Structural organization of intensive care units is known as a key element for maintaining the quality of care of these fragile patients. The reconstruction of megaunits of intensive care to smaller care units within a single operational service might help with provision of safe and effective care.<h4>Methods/design</h4>The clinical team an ...[more]

PMID: 28109276

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Project description:BackgroundNeonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented.ObjectiveTo determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates.MethodsWe conducted a cross-sectional study at a level III NICU located in a rural part of western India. A total of 69 neonates admitted for more than 24 h were included. Twenty-nine neonates were directly observed for a total of 24 h each, and another 40 neonatal records were retrospectively reviewed for the neonate's first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded. Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Average nurse-patient ratio was also calculated. Data were analyzed using descriptive statistics.ResultsA documentation deficit of 2.2% was observed. The average nurse-patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful, and 2.2 moderately painful) procedures per patient day. Common stressful procedures were position changing (2501) and temperature recording (2208). Common mildly and moderately painful procedures were heel prick (757) and endotracheal suctioning (526), respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia.ConclusionStressful procedures are common in the NICU; mildly and moderately painful procedures fairly common. Almost two-thirds of the times, no pharmaceutical pain relief methods were used, and when administered, the pharmaceutical agents were seldom intended for pain relief; this implies poor pain management practices and emphasizes the imperative need for educating NICU nurses, residents, fellows, and attendings.

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Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach.

Publications

Introduction of microsystems in a level 3 neonatal intensive care unit-an interprofessional approach.

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