在引产过程中加强基于证据的实践和以人为中心的护理:来自在低资源环境中进行的质量改进研究的见解
Mohamed Rishard1,2, Hasna Riyal1, Indu Asanka Jayawardane1,2
1Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
斯里兰卡的一项质量改进倡议加强了劳动诱导实践,改进了文件和同意. 虽然剖腹产率增加,但新生儿结果有所改善,这凸显了在资源较少的环境中需要标准化方案的需要.
科学领域:
- 产科和妇科 产科和妇科
- 改善医疗保健质量 改善医疗保健质量
- 全球健康 全球健康
背景情况:
- 在没有明确迹象的情况下引发分娩是低收入和中等收入国家 (LMIC) 越来越关注的问题,增加了风险和医疗负担.
- 这种做法可能会导致不必要的干预和压力医疗保健资源.
研究的目的:
- 评估质量改进 (QI) 倡议对基于证据的实践和以人为中心的护理在低资源环境中的分娩诱导期间的影响.
- 评估与劳动诱导有关的关键绩效指标的变化.
主要方法:
- 在斯里兰卡的一家三级医院 (2019-2022) 进行了四阶段的QI计划 (审计,干预联合创建,实施,重新审计).
- 干预措施包括提供者培训,协议开发,安全检查清单和患者信息传单.
主要成果:
- 在记录劳动诱导 (59%至90%),获得知情同意 (2%至91%) 和诱导前评估 (30.8%至100%) 的指示方面观察到显著改善.
- 福利导管的使用增加了 (39%至68%),而剖腹产率上升了 (22.3%至35.4%),可能是由于人员配置,药物供应和孕产妇肥胖症.
- 新生儿结局,包括特殊护理单位的入院和产后死亡率,呈现出改善.
结论:
- 标准化的诱导协议和持续监测对于改善LMIC的孕产妇护理质量至关重要.
- 需要进一步的研究,以解决增加的剖腹产率和减少不必要的干预,同时确保高质量的护理.
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