National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (5)
- Adverse Events (14)
- Antimicrobial Stewardship (1)
- Caregiving (1)
- Care Management (2)
- Case Study (1)
- Children/Adolescents (3)
- Communication (3)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- Critical Care (3)
- Diagnostic Safety and Quality (3)
- Education: Continuing Medical Education (1)
- Electronic Health Records (EHRs) (2)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (1)
- Evidence-Based Practice (1)
- Genetics (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (4)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (2)
- Health Services Research (HSR) (1)
- Hospitals (1)
- Infectious Diseases (2)
- Injuries and Wounds (2)
- Intensive Care Unit (ICU) (9)
- Kidney Disease and Health (1)
- Labor and Delivery (7)
- Maternal Care (2)
- Medicaid (1)
- Medical Errors (3)
- Medication (7)
- Medication: Safety (4)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (2)
- Neonatal Intensive Care Unit (NICU) (10)
- Neurological Disorders (1)
- (-) Newborns/Infants (34)
- Nursing (2)
- Opioids (2)
- Outcomes (4)
- Patient-Centered Outcomes Research (1)
- (-) Patient Safety (34)
- Pregnancy (5)
- Pressure Ulcers (1)
- Prevention (4)
- Provider: Health Personnel (1)
- Quality Improvement (5)
- Quality of Care (5)
- Registries (3)
- Risk (1)
- Simulation (2)
- Surgery (1)
- Surveys on Patient Safety Culture (1)
- Teams (3)
- TeamSTEPPS (2)
- Tools & Toolkits (1)
- Training (2)
- Treatments (1)
- Women (2)
- Workflow (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 34 Research Studies DisplayedShafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Besagar S, Robles PLA, Rojas C
"What's in a name?" Identification of newborn infants at birth using their given names.
This study’s objective was to determine the proportion of pregnant women who selected names for their babies before they were born or at birth and were willing to disclose them for use in hospital systems, thereby reducing infant identification errors. A survey of pregnant women admitted to postpartum or antepartum units at a large academic hospital was conducted. Of postpartum participants, 79% had names for their newborns at birth. The proportion was significantly lower in self-identified non-Hispanic, white, and married women. Of antepartum participants, 65.7% had selected a name by the time they were surveyed.
AHRQ-funded; HS026121.
Citation: Besagar S, Robles PLA, Rojas C .
"What's in a name?" Identification of newborn infants at birth using their given names.
J Perinatol 2022 Jun;42(6):752-55. doi: 10.1038/s41372-021-01270-9..
Keywords: Newborns/Infants, Patient Safety
Fris E, Sedlock E, Etchegaray J
Development and testing of the Stakeholder Quality Improvement Perspectives Survey (SQuIPS).
The authors created a theory-informed survey that quality improvement (QI) teams can use to understand stakeholder perceptions of an intervention. Through a cross-sectional survey of QI stakeholders, they found that The Stakeholder Quality Improvement Perspectives Survey was feasible for QI teams to use, and it identified stakeholder perspectives about QI interventions that leaders used to alter their QI interventions to potentially increase the likelihood of stakeholder acceptance of the intervention.
AHRQ-funded; HS024459.
Citation: Fris E, Sedlock E, Etchegaray J .
Development and testing of the Stakeholder Quality Improvement Perspectives Survey (SQuIPS).
BMJ Open Qual 2021 Dec;10(4). doi: 10.1136/bmjoq-2020-001332..
Keywords: Quality Improvement, Quality of Care, Neonatal Intensive Care Unit (NICU), Patient Safety, Newborns/Infants
Brei BK, Sawyer T, Umoren R
Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS.
This study looked at whether the presence of family members had an impact on neonatal tracheal intubation (TI) outcomes. This retrospective analysis looked at TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS) at 13 academic NICUS from October 2014 to December 2017. Family members were present in less than 10% of TIs, but this varied by site. Success rates were not significantly different, with the first attempt success rate at 55% with family present versus 49% and success within 2 attempts was 74% versus 66%. Adverse TI-associated events (TIAEs) were 17% versus 20% and severe oxygen desaturation was 49% versus 52%. No independent association between any of these outcomes was found with family presence.
AHRQ-funded; HS027259; HS024511.
Citation: Brei BK, Sawyer T, Umoren R .
Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS.
Arch Dis Child Fetal Neonatal Ed 2021 Jul;106(4):392-97. doi: 10.1136/archdischild-2020-319709..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Registries, Patient Safety
Feldman AG, Parsons JA, Dutmer CM
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
This paper reports on two cases of transient, drug-induced liver failure after gene replacement therapy using an adeno-associated virus vector containing the survival motor neuron 1 gene.
AHRQ-funded; HS026510.
Citation: Feldman AG, Parsons JA, Dutmer CM .
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
J Pediatr 2020 Oct;225:252-58.e1. doi: 10.1016/j.jpeds.2020.05.044..
Keywords: Newborns/Infants, Neurological Disorders, Genetics, Treatments, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Case Study
Dadiz R, Riccio J, Brown K
Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit.
This study’s objective was to identify 1) latent safety threats (LSTs) in a new neonatal intensive care unit (NICU) through simulation-based pre-occupancy operations testing, and 2) LSTs that remained unresolved 1-year post-occupancy. This qualitative study included 111 healthcare professionals who participated in patient care simulations and debriefings in a new NICU. Debriefing transcripts were analyzed to characterize LSTs. Three-hundred threats with four major themes affecting staff function and patient safety emerged: relay of information, workplace design, patient care processes, and patient family and staff focus. One-year post occupancy 29 (9%) LSTs were still unresolved.
AHRQ-funded; R18 HS023460.
Citation: Dadiz R, Riccio J, Brown K .
Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit.
J Perinatol 2020 Sep;40(Suppl 1):29-35. doi: 10.1038/s41372-020-0749-3..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Patient Safety, Simulation
Herrick HM, Lorch S, Hsu JY
Impact of flow disruptions in the delivery room.
The goal of this study was to identify the impact of flow disruptions during neonatal resuscitation and to determine their association with key process and outcome measures. Delivery-room resuscitations of neonates less 32 weeks gestational age were video recorded for observation. Results showed that flow disruptions occurred frequently during neonatal resuscitation and recommendations included measuring flow disruptions as a feasible method to assess the impact of human factors in the delivery room and to identify modifiable factors and practices to improve patient care.
AHRQ-funded; HS023538; HS026491; HS026625; HS023806.
Citation: Herrick HM, Lorch S, Hsu JY .
Impact of flow disruptions in the delivery room.
Resuscitation 2020 May;150:29-35. doi: 10.1016/j.resuscitation.2020.02.037.
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Keywords: Workflow, Labor and Delivery, Newborns/Infants, Patient Safety, Healthcare Delivery, Quality Improvement, Quality of Care
Sherman JP, Hedli LC, Kristensen-Cabrera AI
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. In this study, the investigators employed design thinking methodology to understand how the design of labor and delivery units impacted safety and identified spaces and systems where improvements are needed.
AHRQ-funded; HS023506.
Citation: Sherman JP, Hedli LC, Kristensen-Cabrera AI .
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
Am J Perinatol 2020 May;37(6):638-46. doi: 10.1055/s-0039-1685494..
Keywords: Labor and Delivery, Pregnancy, Patient Safety, Maternal Care, Women, Newborns/Infants
Pfeifer E, Lozovatsky M, Abraham J
Effect of an alternative newborn naming strategy on wrong-patient errors: a quasi-experimental study.
Newborns are often assigned temporary names at birth. Temporary newborn names-often a combination of the mother's last name and the newborn's gender-are vulnerable to patient misidentification due to similarities with other newborns or between a mother and her newborn. In this study, the investigators developed and implemented an alternative distinct naming strategy, and then compared its effectiveness on reducing the number of wrong-patient orders with the standard distinct naming strategy.
AHRQ-funded; HS025443.
Citation: Pfeifer E, Lozovatsky M, Abraham J .
Effect of an alternative newborn naming strategy on wrong-patient errors: a quasi-experimental study.
Appl Clin Inform 2020 Mar;11(2):235-41. doi: 10.1055/s-0040-1705175..
Keywords: Newborns/Infants, Medical Errors, Adverse Events, Patient Safety
Milstone AM, Voskertchian A, Koontz DW
Effect of treating parents colonized with Staphylococcus aureus on transmission to neonates in the intensive care unit: a randomized clinical trial.
This study examined the effect of treating parents of neonates in the intensive care unit (NICUs) with intranasal mupirocin and topical chlorhexidine compared with a placebo treatment and whether it reduces transmission of Staphlyococcus aureus to their babies. A double-blind randomized trial was conducted at 2 tertiary NICUs in Baltimore, MD from November 2014 to December 2018. Parents were given intranasal treatments for 5 days. Of the intervention group 13 of 89 neonates acquired S aureus, and in the control group 29 of 101 neonates acquired S aureus with the same strain as their parents. The results showed a significant reduction in transmission.
AHRQ-funded; HS022872.
Citation: Milstone AM, Voskertchian A, Koontz DW .
Effect of treating parents colonized with Staphylococcus aureus on transmission to neonates in the intensive care unit: a randomized clinical trial.
JAMA 2020 Jan;323(4):295-386. doi: 10.1001/jama.2019.20785..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention
Stoops C, Stone S, Evans E
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
The purpose of this study was to test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting. The authors concluded that a systematic surveillance program to identify high-risk infants can prevent nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.
AHRQ-funded; HS023763.
Citation: Stoops C, Stone S, Evans E .
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
J Pediatr 2019 Dec;215:223-28.e6. doi: 10.1016/j.jpeds.2019.08.046..
Keywords: Newborns/Infants, Medication, Medication: Safety, Patient Safety, Kidney Disease and Health, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Prevention, Adverse Drug Events (ADE), Adverse Events
Shafer G, Singh H, Suresh G
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
In this narrative review, the authors discuss how the concept of diagnostic errors framed as missed opportunities can be applied to the non-linear nature of diagnosis in a critical care environment such as the NICU. They then explore how the etiology of an error in diagnosis can be related to both individual cognitive factors as well as organizational and systemic factors - all of which often contribute to the error.
AHRQ-funded; HS022087.
Citation: Shafer G, Singh H, Suresh G .
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
Semin Perinatol 2019 Dec;43(8):151175. doi: 10.1053/j.semperi.2019.08.004..
Keywords: Newborns/Infants, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Medical Errors, Adverse Events, Patient Safety
Adelman JS, Applebaum JR, Southern WN
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
Researchers assessed the risk of wrong-patient orders among multiple-birth infants and singletons receiving care in the NICU and examined the proportion of wrong-patient orders between multiple-birth infants and siblings (intrafamilial errors) and between multiple-birth infants and nonsiblings (extrafamilial errors). They found that multiple-birth status in the NICU is associated with significantly increased risk of wrong-patient orders compared with singleton-birth status. Strategies to reduce this risk include using given names at birth, changing from temporary to given names when available, and encouraging parents to select names for multiple births before they are born when acceptable to families.
AHRQ-funded; HS024538.
Citation: Adelman JS, Applebaum JR, Southern WN .
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
JAMA Pediatr 2019 Oct 10;173(10):979-85. doi: 10.1001/jamapediatrics.2019.2733..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Knox CA, Hampp C, Palmsten K
Validation of mother-infant linkage using Medicaid Case ID variable within the Medicaid Analytic eXtract (MAX) database.
The authors established and validated an algorithm within the Medicaid Analytic eXtract (MAX) that links mothers to infants and to identify factors influencing successful mother-infant linkage. They found that their algorithm can correctly link liveborn infants to their mothers, with linkage performance being associated with certain characteristics that may affect representativeness of successfully linked pairs.
AHRQ-funded; HS022384.
Citation: Knox CA, Hampp C, Palmsten K .
Validation of mother-infant linkage using Medicaid Case ID variable within the Medicaid Analytic eXtract (MAX) database.
Pharmacoepidemiol Drug Saf 2019 Sep;28(9):1222-30. doi: 10.1002/pds.4843..
Keywords: Caregiving, Medicaid, Newborns/Infants, Patient Safety, Pregnancy
Ozawa Y, Ades A, Foglia EE
Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events.
This study assessed the impact of using sedation with neuromuscular blockade in non-emergency tracheal intubation of neonates. The retrospective cohort was from infants in neonatal intensive care units (NICUs) participating the National Emergency Airway Registry for Neonates from 2014 to 2017. There was less adverse events associated with use of the neuromuscular blockade premedication.
AHRQ-funded; HS024511.
Citation: Ozawa Y, Ades A, Foglia EE .
Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events.
J Perinatol 2019 Jun;39(6):848-56. doi: 10.1038/s41372-019-0367-0..
Keywords: Adverse Events, Medication, Newborns/Infants, Outcomes, Patient Safety, Registries
Lapcharoensap W, Cong A, Sherman J
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
This study discussed the reasons that delayed cord clamping (DCC) for term and preterm infants is endorsed by multiple medical organizations. It has been shown to reduce hemorrhage, lower incidence of necrotizing enterocolitis and the need for transfusions in preterm infants. The writers held a number of multidisciplinary simulation workshops of vaginal and Caesarean deliveries, with providers starting positive pressure ventilation and ending with CPAP on a preterm manikin. Videos were also reviewed and identified 5 themes of concern: sterility, equipment, mobility, space, and workflow.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Cong A, Sherman J .
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
Children 2019 Apr 13;6(4). doi: 10.3390/children6040059..
Keywords: Adverse Events, Labor and Delivery, Newborns/Infants, Patient Safety
Kahwati LC, Sorensen AV, Teixeira-Poit S
AHRQ Author: Mistry KB
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
The purpose of this study was to describe the Safety Program for Perinatal Care (SPPC) implementation experience and evaluate the short-term impact on labor and delivery (L&D) unit patient safety culture, processes, and adverse events. SPPC implementation by L&D units were supported sing a program toolkit, trainings, and technical assistance. Researchers then evaluated the program using a pre-post, mixed-methods design. Changes in safety and quality were measured using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators. Findings showed that SPPC had a favorable impact on unit patient safety culture and processes, but mixed short-term impact on maternal and neonatal adverse events.
AHRQ-authored; AHRQ-funded; 2902010000241.
Citation: Kahwati LC, Sorensen AV, Teixeira-Poit S .
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
Jt Comm J Qual Patient Saf 2019 Apr;45(4):231-40. doi: 10.1016/j.jcjq.2018.11.002..
Keywords: Adverse Events, Communication, Comprehensive Unit-based Safety Program (CUSP), Labor and Delivery, Maternal Care, Newborns/Infants, Outcomes, Patient Safety, Pregnancy, Simulation, Surveys on Patient Safety Culture, Teams, TeamSTEPPS, Training, Women
Santosa KB, Keller M, Olsen MA
Negative-pressure wound therapy in infants and children: a population-based study.
Although the safety and benefits of negative-pressure wound therapy (NPWT) have been clearly demonstrated in the adult population, studies evaluating the safety and describing the use of NPWT in the pediatric population have been limited. In this study, the investigators performed a literature review and analyzed the Truven Health Analytics MarketScan Commercial Claims Databases from 2006 to 2014 to identify infants and children treated with NPWT.
AHRQ-funded; HS019455.
Citation: Santosa KB, Keller M, Olsen MA .
Negative-pressure wound therapy in infants and children: a population-based study.
J Surg Res 2019 Mar;235:560-68. doi: 10.1016/j.jss.2018.10.043..
Keywords: Children/Adolescents, Newborns/Infants, Pressure Ulcers, Injuries and Wounds, Care Management, Patient Safety
Foglia EE, Ades A, Sawyer T
Neonatal intubation practice and outcomes: an international registry study.
Neonatal tracheal intubation is a critical but potentially dangerous procedure. In this study, the investigators sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety. They developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. They suggest that their results will inform future interventional studies to improve neonatal intubation safety.
AHRQ-funded; HS024511.
Citation: Foglia EE, Ades A, Sawyer T .
Neonatal intubation practice and outcomes: an international registry study.
Pediatrics 2019 Jan;143(1). doi: 10.1542/peds.2018-0902..
Keywords: Emergency Department, Health Services Research (HSR), Intensive Care Unit (ICU), Newborns/Infants, Outcomes, Patient Safety, Registries
Pouppirt NR, Nassar R, Napolitano N
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
The purpose of this single-site retrospective cohort study was to consider the possible effect of video laryngoscopy on adverse events during neonatal tracheal intubation. The researchers conclude that video laryngoscopy was independently associated with decreased risk for adverse events.
AHRQ-funded; HS022464; HS024511.
Citation: Pouppirt NR, Nassar R, Napolitano N .
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
J Pediatr 2018 Oct;201:281-84.e1. doi: 10.1016/j.jpeds.2018.05.046..
Keywords: Adverse Events, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Patient Safety
Basco WT, Roberts JR, Ebeling M
Indications for use of combination acetaminophen/opioid drugs in infants <6 months old.
This study examined the use of combination acetaminophen/opioid drugs in infants 0-6 months old. In most cases it is not considered appropriate for children under 2 years and for respiratory diagnosis is not appropriate at all. Pharmacy claims from the South Carolina Medicaid prescriptions database from January 2011 through August 2012 was evaluated. The data was given to researchers in de-identified format from 3 Medicaid files. No newborns (aged <1 month) were given these combination drugs. They calculated that 1 in 5 prescriptions were given for an inappropriate indication, and 1 in 10 for respiratory diagnosis.
AHRQ-funded; HS015679.
Citation: Basco WT, Roberts JR, Ebeling M .
Indications for use of combination acetaminophen/opioid drugs in infants <6 months old.
Clin Pediatr 2018 Jun;57(6):741-44. doi: 10.1177/0009922817730349..
Keywords: Opioids, Newborns/Infants, Medication, Patient Safety
Dudding KM, Gephart SM, Carrington JM
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record.
AHRQ-funded; HS022908.
Citation: Dudding KM, Gephart SM, Carrington JM .
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
Comput Inform Nurs 2018 Apr;36(4):167-76. doi: 10.1097/cin.0000000000000406.
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Keywords: Electronic Health Records (EHRs), Neonatal Intensive Care Unit (NICU), Newborns/Infants, Nursing, Patient Safety
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Khamash DF, Voskertchian A, Milstone AM
Manipulating the microbiome: evolution of a strategy to prevent S. aureus disease in children.
Hospitalized infants have the highest rates of invasive Staphylococcus aureus disease of any population and infection control strategies such as decolonization have been insufficient. In this article, the authors review what is known about bacterial communities in the nasal cavity of infants and discuss how future microbiome studies may help identify novel interventions to protect high-risk infants from S. aureus disease.
AHRQ-funded; HS022872.
Citation: Khamash DF, Voskertchian A, Milstone AM .
Manipulating the microbiome: evolution of a strategy to prevent S. aureus disease in children.
J Perinatol 2018 Feb;38(2):105-09. doi: 10.1038/jp.2017.155..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Children/Adolescents, Prevention, Newborns/Infants, Patient Safety
Lapcharoensap W, Lee HC
Tackling quality improvement in the delivery room.
Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room quality improvement (QI). Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Lee HC .
Tackling quality improvement in the delivery room.
Clin Perinatol 2017 Sep;44(3):663-81. doi: 10.1016/j.clp.2017.05.003.
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Keywords: Communication, Labor and Delivery, Newborns/Infants, Quality Improvement, Patient Safety