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Discharge planning and guidance for preterm newborns: a best practice implementation project
Karina Faria de Souza1,2,3, Denise Gomes Miyazato1, Bárbara Barros Pereira Lobo1
1University Hospital, University of São Paulo, São Paulo, SP, Brazil.
Insights
Improving discharge planning for preterm infants enhances family readiness and reduces neonatal risks. This study enhanced guidance and practices, though sustained improvements require ongoing attention.
Area of Science:
- Neonatal care
- Evidence-based practice
- Healthcare quality improvement
Background:
- Prematurity is a major cause of neonatal morbidity and mortality, with significant long-term health risks.
- Inadequate discharge planning can negatively impact family readiness and infant health outcomes.
- Existing guidelines for preterm infant discharge often have gaps between evidence and clinical practice.
Purpose of the Study:
- To enhance discharge planning and family guidance for preterm newborns.
- To evaluate compliance with evidence-based discharge criteria.
- To standardize documentation and unify discharge information for families.
Main Methods:
- A quasi-experimental before-and-after study using the JBI Evidence Implementation Framework.
- Involved clinical audits, barrier/enabler assessment, and multimodal implementation strategies.
- Utilized an Institutional Care Guideline, family-friendly booklet, flowcharts, and digital dissemination.
Main Results:
- No statistically significant differences were observed between baseline and follow-up audits.
- Two discharge criteria were fully met at baseline; compliance improved for four of nine audited criteria.
- Multimodal strategies, including educational materials and digital dissemination, supported the changes.
Conclusions:
- The project successfully improved discharge practices and family guidance for preterm infants.
- Multidisciplinary collaboration was key to enhancing the discharge process.
- Sustaining these improvements necessitates continuous focus and effort.
Introduction:
Prematurity, affecting approximately 10% of births, is a leading cause of neonatal morbidity and mortality. It is associated with neurological, respiratory, feeding, visual, and auditory problems; developmental delays; and chronic disease risks. The earlier the birth, the greater the risks. Lack of proper discharge planning can impair the health care team's assessment of a family's readiness, increasing morbidity. Although guidelines have been developed to support clinical discharge practices for preterm infants, gaps remain between evidence and practice.
Aim:
This project aimed to improve discharge planning and guidance for families or legal guardians of preterm newborns; assess compliance with evidence-based discharge criteria; standardize documentation; and unify discharge guidance provided to families of preterm infants admitted to the neonatal unit of a teaching hospital in São Paulo, Brazil.
Methods:
A quasi-experimental before-and-after study was conducted using the JBI Evidence Implementation Framework, which combines clinical audits with a structured process to address barriers and enablers to evidence-based practice. The methodology includes identifying the practice area, engaging change agents, assessing context and readiness, baseline audits, implementing changes, follow-up audits, and evaluating sustainability.
Results:
No statistically significant differences were found between the baseline and follow-up audits. Two criteria were already fully met. Four of the nine audited criteria showed improved compliance. Changes were supported by multimodal strategies, including an Institutional Care Guideline, an illustrated booklet with clear language for families, flowcharts to guide discharge planning, dissemination via AI-powered video and social media.
Conclusions:
The project enhanced discharge practices and guidance for families through multidisciplinary collaboration. Sustaining improvements will require ongoing attention.
Spanish Abstract:
http://links.lww.com/IJEBH/A645.
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