Reducing Iatrogenic Blood Losses in Premature Infants.
OBJECTIVE: Iatrogenic blood losses from repetitive laboratory testing are a leading cause of anemia of prematurity and blood transfusions. We used an implementation science approach to decrease iatrogenic blood losses during the first 3 postnatal weeks among very low birth weight infants. METHODS: W...
| Publicado en: | Pediatrics Vol. 154; no. 4; pp. 1 - 16 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
American Academy of Pediatrics
Oct2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=180068091&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 180068091 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00314005 PDT jtl: Pediatrics issn: 00314005 maglogo: N pubinfo: dt: Oct2024 vid: 154 iid: 4 pid: 1659 pub: American Academy of Pediatrics place: Elk Grove Village, Illinois artinfo: ui: 180068091 180068091 180068091 10.1542/peds.2024-065921 180068091 ppf: 1 ppct: 15 formats: tig: atl: Reducing Iatrogenic Blood Losses in Premature Infants. aug: au: Sharma, Megha Bowman, Emily Feng Zheng Spencer, Horace J. Shukri, Shaymaa-Al Gates, Kim Williams, Misty Peeples, Sara Hall, Richard W. Schootman, Mario Landes, Sara J. Curran, Geoffrey M. affil: Department of Pediatrics, Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas sug: subj: Iatrogenic Disease Anemia, Neonatal Prevention and Control Infant, Very Low Birth Weight Human Funding Source Implementation Science Postnatal Period Qualitative Studies Interviews Conceptual Framework Diagnostic Tests, Routine Laboratories Evaluation Poisson Distribution Multivariate Analysis Regression Costs and Cost Analysis Professional Knowledge Unnecessary Procedures Medical Orders Interns and Residents Education Audit Feedback Documentation Descriptive Statistics Infant, Newborn Infant, Newborn: birth-1 month ab: OBJECTIVE: Iatrogenic blood losses from repetitive laboratory testing are a leading cause of anemia of prematurity and blood transfusions. We used an implementation science approach to decrease iatrogenic blood losses during the first 3 postnatal weeks among very low birth weight infants. METHODS: We performed qualitative interviews of key stakeholders to assess implementation determinants (ie, barriers and facilitators to reducing iatrogenic blood losses), guided by the Consolidated Framework for Implementation Research. Next, we selected implementation strategies matched to these implementation determinants to de-implement excess laboratory tests. The number of laboratory tests, amount of blood taken (ml/kg), and laboratory charges were compared before and after implementation using quasi-Poisson and multi-variable regression models. RESULTS: Qualitative interviews with 14 clinicians revealed implementation-related themes, including provider-specific factors, recurring orders, awareness of blood loss and cost, and balance between over- and under-testing. Implementation strategies deployed included resident education, revised order sets, blood loss and cost awareness, audit and feedback, and the documentation of blood out. There were 184 and 170 infants in the pre- and postimplementation cohorts, respectively. There was an 18.5% reduction in laboratory tests (median 54 [36-80] versus 44 [29-74], P = .01) in the first 3 postnatal weeks, a 17% decrease in blood taken (mean 18.1 [16.4-20.1] versus 15 [13.4-16.8], P = .01), and an overall reduction of $290 328 in laboratory charges. No difference was noted in the number of blood transfusions. Postimplementation interviews showed no adverse events attributable to implementation strategies. CONCLUSIONS: An implementation science approach combining qualitative and quantitative methods reduced laboratory tests, blood loss, and charges. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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