NICU Performance: Missed Nursing Care and Infant Outcomes

NICU 表现：错过护理和婴儿结局

• 批准号: 9352303
• 负责人: EILEEN T LAKE
• 金额: $ 39.52万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9352303
• 关键词: NICU; Performance; Missed; Nursing; Care

NICU PERFORMANCE: MISSED NURSING CARE AND INFANT OUTCOMES   More than half of all infant deaths annually in the U.S. are accounted for by infants with very low birth weight (VLBW)(< 1500 grams or 3.3 lbs.), indicating the high mortality burden carried by the over 60,000 infants born with VLBW. One in four VLBW infants dies; nine out of ten of these deaths occur in the first month of life while hospitalized in the neonatal intensive care unit (NICU). There are large unexplained variations in VLBW infant mortality across NICUs that cannot be accounted for by infant risk factors, providing a compelling need to examine factors in the health care system that account for these variations. Since optimal management of VLBW infants depends on skilled nursing care, with the average NICU nurse caring for 2 or 3 infants at a time, we seek to ascertain if missed nursing care accounts for variation in infant mortality, nosocomial infection, length of stay, and parental satisfaction in order to identify points of intervention to improve outcomes. Missed nursing care, defined as required nursing care that is omitted or delayed in response to multiple demands or inadequate resources, occurs in this setting with potentially important consequences on patient outcomes. Therefore there is a critical need to quantify the impact on infants and parents and to identify the factors responsible for missed nursing care. The results of this study will allow for the development of novel, evidence-based, and clinically effective strategies to improve the health and life course of VLBW infants. To determine the effects of missed care on infant outcomes and parent satisfaction and to determine factors associated with missed NICU nursing care, we will first merge four large datasets: 1) the National Database of Nursing Quality Indicators Registered Nurse Survey (NDNQI RN Survey) which includes information on missed care nursing, the nurse work environment and acuity-adjusted NICU nurse workload, 2) the Healthcare Cost and Utility Project State Inpatient Data that provides data on patient outcomes, 3) the American Hospital Association data on hospital structural measures, and 4) the Medicare Cost Report, which provides data on financial margins. Then, we will study parental satisfaction through a survey 240 parents of VLBW infants in 24 NDNQI units linked to the NDNQI RN survey data. With data from 89 NICUs across the nation (representing 5,785 VLBW infants) we will be able to (Aim 1): Determine associations between missed nursing care and NICU patient outcomes for VLBW infants. With the primary parent survey data we will be able to (Aim 2): Determine the association between missed nursing care and parent satisfaction with care in the NICU; and with data from 8,950 RNs employed in 179 NICUs be able to (Aim 3): Identify nurse and NICU organizational factors associated with missed nursing care. This research will result in healthier lives and better parental experiences for high-risk infants treated in the NICU by improving nursing care.

NICU表现：错过护理和婴儿成果   在美国，每年有一半以上的婴儿死亡是由非常低出生的婴儿所占的 重量（VLBW）（<1500克或3.3磅），表明超过60,000的高死亡率燃烧 患有VLBW的婴儿。四分之一的VLBW婴儿死亡；这些死亡中的十分之九发生在第一个月 在新生儿重症监护病房（NICU）住院时的生活。有很大的无法解释的变化 NICUS的VLBW婴儿死亡率无法由婴儿风险因素解释，从而提供了引人注目的 需要检查卫生保健系统中解释这些变化的因素。自从最佳 VLBW婴儿的管理取决于熟练的护士护理，普通的NICU护士照顾2或3 婴儿一次，我们试图确定是否缺少护士护理帐户，以了解婴儿死亡率的差异， 医院感染，住院时间和父母满意度，以确定干预点 改善结果。错过的护理护理，定义为所需的护理护理，被省略或延迟 对多种需求或资源不足的响应，发生在这种情况下，可能很重要 对患者预后的后果。迫切需要量化对婴儿的影响和 父母并确定导致缺失护士护理的因素。这项研究的结果将允许 开发新颖，循证和临床有效策略以改善健康和生活 VLBW婴儿的过程。确定错过护理对婴儿结果和父母满意度的影响 为了确定与错过的NICU护理护理相关的因素，我们将首先合并四个大型数据集：1） 国家护理质量指标的国家数据库注册护士调查（NDNQI RN调查） 包括有关错过护理护士，护士工作环境和敏锐调整的NICU护士的信息 工作量，2）提供有关患者数据的医疗保健成本和公用事业项目状态住院数据 结果，3）美国医院协会有关医院结构措施的数据，4）Medicare 成本报告，提供有关财务利润率的数据。然后，我们将通过 调查240个与NDNQI RN调查数据相关的NDNQI单位中VLBW婴儿的父母。带有来自89的数据 全国的NICU（代表5,785个VLBW婴儿），我们将能够（AIM 1）：确定协会 VLBW婴儿的错过护理护理和NICU患者结果之间。与主要父母调查 我们将能够（AIM 2）的数据：确定错过的护士护理与父母满意度之间的关联 在NICU小心；并且有8,950 RN的数据在179 NICUS中工作了（AIM 3）：确定护士 和NICU的组织因素与错过的护理护理有关。这项研究将使更健康 通过改善护士护理，可以为在NIC中治疗的高危婴儿生活和更好的父母体验。