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Quality Strategies Initiative for the Improvement of Delayed Cord Clamping Among Preterm Neonates: A Quality
Ahmed Elabbasy1, Inas Babic2,3, Malak Saleh Alghamdi4
1Division of Neonatal Intensive Care, Department of Pediatrics, Prince Sultan Military Medical City, Ministry of Defense Health Services, Riyadh, Saudi Arabia.
Insights
Implementing organized interventions significantly increased delayed cord clamping (DCC) rates in preterm infants from 3% to 92%. This practice shows promise for improving neonatal outcomes and establishing better DCC standards globally.
Area of Science:
- Neonatal Medicine
- Pediatric Health
- Clinical Practice Improvement
Background:
- Delayed cord clamping (DCC) offers significant benefits for infant health, reducing neonatal morbidity and mortality through autotransfusion.
- Despite demonstrated advantages, DCC is not yet a routine clinical practice worldwide.
- The implementation of DCC is crucial for improving newborn well-being.
Purpose of the Study:
- To enhance the rate of delayed cord clamping (DCC) for eligible preterm newborns at a tertiary hospital in Riyadh, Saudi Arabia.
- To establish and improve DCC compliance among healthcare providers for preterm infants.
- To assess the impact of targeted interventions on DCC adoption.
Main Methods:
- A Plan-Do-Study-Act (PDSA) methodology was employed over a 12-month period (June 2023-June 2024).
- Interventions included comprehensive workforce education, standardized procedure enhancement, diligent monitoring, and effective resource management.
- The study focused on preterm infants under 35 weeks gestation.
Main Results:
- Initial DCC compliance was critically low at 0-3%.
- Following the implementation of interventions, DCC rates surged to 92%, consistently exceeding the 60% benchmark.
- No adverse maternal or neonatal events were reported during the study period.
Conclusions:
- Organized interventions are highly effective in significantly increasing DCC rates among preterm infants.
- The successful approach can be replicated in other healthcare settings to improve neonatal outcomes.
- This study highlights the potential of DCC to enhance standards of neonatal care.
Background:
Delayed cord clamping (DCC) has significant impact on health and well-being of preterm and term infants locally and worldwide. Effect of autotransfusion from delayed cord clamping has demonstrated significant beneficial effects in decreasing neonatal morbidity and mortality. However, this implementation has not been routinely established in clinical practice.
Aim:
To improve the percentage of eligible infants who receive DCC among preterm newborns at tertiary hospital in Riyadh, Saudi Arabia.
Methods:
The study was conducted between June 2023 and June 2024 at tertiary hospital, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. We applied Plan-Do-Study-Act (PDSA) as a structured approach. The study population was defined as preterm infants aged <35 weeks. Interventions that were used included: workforce education, improving standardized procedures, monitoring and evaluation, and resources management. The DCC compliance rate was measured, in addition to employee training attendance and documentation methods.
Results:
At the beginning of this study, the rate of DCC procedure was very low, and accounted only for 0% to 3%. After the interventions (Education and training, policy development, process monitoring and audits, and resource allocation) were applied, the rate of DCC increased to 92%, and this prevalence remained above the benchmark (60%), plateauing at above 90%. There were no reported maternal or neonatal adverse events.
Conclusion:
This study confirmed that the rate of DCC increased after using the appropriate organized interventions. Applying the same or similar approach in other medical settings may be a valuable contributor in improving neonatal outcomes in addition to improve the standards related to DCC practices.
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