Developmental Care Practice and Documentation Variability in the Cardiac ICU.
Developmental Care Practice and Documentation Variability in the Cardiac ICU.
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DOI：
10.1097/pcc.0000000000002881
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
Lisanti AJ
中科院分区：
文献类型：
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作者：
Miller TA;Elhoff JJ;Alexander NM;Butler SC;Uzark KC;Glotzbach KL;Mahle WT;Lisanti AJ
描述接受先天性心脏病手术的婴儿在发育护理实践中的变异性，如电子健康记录所示。多中心、回顾性、队列研究6家儿科心脏中心，182名婴儿接受了以下三种手术之一：诺伍德姑息治疗，主动脉弓重建和室间隔缺损闭合术，或动脉转换发育护理的核心领域，包括疼痛评估，喂养，婴儿抱，护理人员参与，治疗和心理社会服务进行了审查。实践因个人、机构和住院时间而异。在6个站点中的5个站点，>90%的个人将物理或职业治疗服务作为其护理的一部分，但首次评估的日期范围从入院到术后第28天。在喂养团队和社会工作参与中也看到了类似的模式。发展保健的一致文件依赖于域和网站。在审查的总天数（n= 1，192）中，记录了95%的疼痛评分。在同一天，记录患者是否离开婴儿床的比例因临床试验机构而异，从11%到93%不等。48%的患者在出院前一天记录经口喂养类型（母乳喂养与奶瓶喂养）。有显着的，可量化的变化，在记录的发展护理做法在个人和网站的水平。需要更可靠的文件的发展保健做法，将这些变量与后来的结果和调查差异个性化的发展保健做法。
Describe variability in developmental care practices, as documented in the electronic health record, for infants undergoing congenital heart surgery Multicenter, retrospective, cohort study Six pediatric cardiac centers 182 infants undergoing one of three index operations: Norwood palliation, aortic arch reconstruction with ventricular septal defect closure, or arterial switch Core domains of developmental care encompassing pain assessment, feeding, infant holding, caregiver involvement, therapy, and psychosocial services were reviewed. Practices varied across individuals, institutions, and the hospital stay. At 5 of 6 sites, >90% of individuals had physical or occupational therapy services as part of their care, but the day of first evaluation ranged from day of admission to post-operative day 28. Similar patterns were seen in feeding team and social work involvement. Consistent documentation of developmental care was dependent on the domain and site. Of the total days reviewed (n=1,192), pain scores were documented in 95%. In those same days, documentation of whether or not a patient was out of the crib to be held varied by site from 11–93%. Type of oral feeding, breast versus bottle, was documented on the day prior to discharge 48% of the time. There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices.