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Systems analysis of guideline adherence in neonatal intensive care

新生儿重症监护指南依从性的系统分析

基本信息

批准号：
9300992
负责人：
Heather Lynn Tubbs Cooley
金额：
$ 6.15万
依托单位：
CINCINNATI CHILDRENS HOSP MED CTR
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2017-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9300992
关键词：
Address Adherence Affect American Aviation Blood Caring Childhood Critically ill children Data Collection Devices Education Engineering Environment Evaluation Failure Focus Groups Goals Guideline Adherence Guidelines Healthcare Hospitals Human Individual Industry Infant Infection Infection prevention Infusion Nursing Infusion procedures Intervention Interview Intravenous Joints Knowledge Lead Maintenance Maps Medication Errors Methods Modeling Neonatal Neonatal Intensive Care Neonatal Intensive Care Units Nosocomial Infections Nurses Outcome Output Overdose Performance Pharmaceutical Preparations Phase Physical environment Policies Procedures Process Provider Public Health Reporting Research Respondent Rights Risk Risk Assessment Safety Sepsis Severities Source Stream Surveys System Systems Analysis Systems Development Technology Testing Time Variant Video Recording Work design direct patient care evidence base experience hazard high risk improved neonatal patient neonate nuclear power patient safety prevent prospective public health relevance shift work standardized care tool

项目摘要

DESCRIPTION (provided by applicant): Despite significant national progress in reducing central line-associated blood stream infection (CLABSI) rates, CLABSI remains a leading cause of preventable healthcare-associated harm in American neonatal intensive care units (NICUs). Most CLABSIs occur after central line insertion during the maintenance phase when central lines are frequently accessed by nurses for intravenous medication administration (IVMA). CLABSIs are mostly preventable when nurses reliably adhere to standardized care processes such as central line maintenance guidelines, yet NICUs report difficulty sustaining guideline adherence. Current approaches to increasing adherence focus on improving individual clinician performance, although such approaches are not effective for sustaining guideline adherence over time. An alternative approach is necessary to sustain CLABSI reductions made through quality improvement efforts. We propose to rigorously identify hazards and assess risks associated with NICU nurses' adherence to CLABSI and IVMA guidelines. We will take a human factors engineering approach and use the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety to conduct a prospective risk assessment of guideline adherence. The specific aims of the study are to 1) Identify hazards in the NICU work system that threaten nurses' adherence to CLABSI and IVMA guidelines and 2) Assess risk of potential failure modes associated with guideline adherence. We will employ both qualitative and quantitative data collection methods to achieve the aims including direct observations, interviews, Healthcare Failures Modes and Effects Analysis, and focus groups conducted with nurses who provide direct patient care in the NICU. This study is relevant to the public's health because it will increase our understanding of how factors in the NICU work system (technologies, tasks, the environment) influence nurses' adherence (and non-adherence) to guidelines intended to prevent hospital-acquired infections and IVMA-related errors. The results of this project will directly inform interventions to improve guideline adherence in the NICU and enhance neonatal patient safety.