Reducing Iatrogenic Blood Losses in Premature Infants.

Autor:	Sharma M; Department of Pediatrics, Division of Neonatology., Bowman E; College of Medicine., Zheng F; Department of Pediatrics, Division of Neonatology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas., Spencer HJ; Department of Biostatistics., Shukri SA; Department of Biomedical Informatics., Gates K; Department of Biomedical Informatics., Williams M; Neonatal Registered Nurse and Clinical Specialist., Peeples S; Department of Pediatrics, Division of Neonatology., Hall RW; Department of Pediatrics, Division of Neonatology., Schootman M; Department of Internal Medicine, Division of Community Health and Research, University of Arkansas for Medical Sciences, Springdale, Arkansas., Landes SJ; Department of Psychiatry, University of Arkansas for Medical Sciences and Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas., Curran GM; Departments of Pharmacy Practice & Psychiatry, Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2024 Oct 01; Vol. 154 (4).
DOI:	10.1542/peds.2024-065921
Abstrakt:	Objective: Iatrogenic blood losses from repetitive laboratory testing are a leading cause of anemia of prematurity and blood transfusions. We used an implementation science approach to decrease iatrogenic blood losses during the first 3 postnatal weeks among very low birth weight infants. Methods: We performed qualitative interviews of key stakeholders to assess implementation determinants (ie, barriers and facilitators to reducing iatrogenic blood losses), guided by the Consolidated Framework for Implementation Research. Next, we selected implementation strategies matched to these implementation determinants to de-implement excess laboratory tests. The number of laboratory tests, amount of blood taken (ml/kg), and laboratory charges were compared before and after implementation using quasi-Poisson and multi-variable regression models. Results: Qualitative interviews with 14 clinicians revealed implementation-related themes, including provider-specific factors, recurring orders, awareness of blood loss and cost, and balance between over- and under-testing. Implementation strategies deployed included resident education, revised order sets, blood loss and cost awareness, audit and feedback, and the documentation of blood out. There were 184 and 170 infants in the pre- and postimplementation cohorts, respectively. There was an 18.5% reduction in laboratory tests (median 54 [36 - 80] versus 44 [29 - 74], P = .01) in the first 3 postnatal weeks, a 17% decrease in blood taken (mean 18.1 [16.4 - 20.1] versus 15 [13.4 - 16.8], P = .01), and an overall reduction of $290 328 in laboratory charges. No difference was noted in the number of blood transfusions. Postimplementation interviews showed no adverse events attributable to implementation strategies. Conclusions: An implementation science approach combining qualitative and quantitative methods reduced laboratory tests, blood loss, and charges. (Copyright © 2024 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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