ABSTRACT
BACKGROUND: An increase in infant drops on a postpartum unit prompted a quality improvement project to examine causes and formulate risk reduction strategies. Review of health records revealed that infant drops occurred more frequently when mothers fell asleep holding infants. METHODS: A prospective descriptive study was conducted with a convenience sample of 101 postpartum mother-infant dyads. Hourly assessments of maternal sleepiness using the Stanford Sleepiness Scale (SSS) and surveillance of patient rooms were performed during hospitalizations (N = 4,550 observations). RESULTS: Mothers slept on average 3.7 hours/day (median = 5.0). Sleepiness followed an expected nighttime routine on postpartum day 1 regardless of when mothers arrived on the unit. Peak sleepiness was observed at 04:00 (mean SSS score = 5.3; standard deviation [SD] = 2.6), and mothers were most awake until 18:00 (mean SSS score = 1.9; SD = 1.7). No infant drops occurred during the project; however, 50 participants required at least one intervention or corrective action to address unsafe sleep. Of 1,718 observations of mothers in bed with their infant, there were 35 instances (2.0%) where nurses observed mothers asleep holding their infant. CONCLUSION: Frequent observations of maternal sleepiness and infant environments may prevent infant drops and provide opportunities for intervening with risk reduction strategies, including education on safe sleep for infants.
Subject(s)
Accidental Falls/prevention & control , Mother-Child Relations , Postpartum Period , Sleep Deprivation , Wakefulness , Adult , Female , Humans , Infant, Newborn , Nursing Staff, Hospital , Population Surveillance , Prospective Studies , Quality Improvement , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVE: To develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH). DESIGN: Online didactic modules in combination with an interdisciplinary skills program consisting of seven hemorrhage-related stations. SETTING/LOCAL PROBLEM: The project was conducted in the Women's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania. Women cared for at this center have comorbidities that place them at greater risk for PPH. A need was identified to implement a multidisciplinary and comprehensive program to assess hemorrhage risk and appropriately recognize and intervene with all PPHs in this setting. PARTICIPANTS: The 276 participants, including registered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff in the hospital's Women's Health Department, completed the initial obstetric hemorrhage program. INTERVENTION/MEASUREMENTS: The program included online didactic modules, seven interdisciplinary skills stations led by trained nurses and providers, and an in situ simulation. Successful completion of the online modules was a prerequisite for participation in the skills stations. All participants completed a written program evaluation at the conclusion of the program. RESULTS: Results of the postassessment survey indicated that participants rated the program 3.94 of 4.00 for overall effectiveness to improve interdisciplinary team responses to PPH. Comments were overwhelmingly positive, and participants expressed increased confidence and knowledge related to PPH after completion of the program. CONCLUSION: An interdisciplinary program that included online didactic modules, interactive skills stations, and simulation improved team confidence and responses to PPH.
Subject(s)
Delivery, Obstetric/adverse effects , Hospital Rapid Response Team/organization & administration , Interdisciplinary Communication , Pregnancy, High-Risk , Quality Improvement , Academic Medical Centers , Adult , Clinical Competence , Delivery, Obstetric/methods , Female , Humans , Patient Care Team/organization & administration , Philadelphia , Pregnancy , Program Development , Program Evaluation , Young AdultABSTRACT
The treatment of pain is an essential component of the clinical and ethical care of infants. Despite evidence-based practice consensus statements recommending that infants receive analgesia during minor painful procedures, numerous studies have shown that procedural pain remains poorly managed in this population. Oral sucrose administration has been associated with calming effects and reductions in observed pain behaviors with preterm and term infants aged up to 1 year. The objective of this integrative review is to synthesize findings from published randomized controlled trials evaluating the efficacy and safety of oral sucrose as a preprocedural intervention for mild to moderate procedural pain in infants. Overall, studies indicate that oral sucrose is an effective, safe, convenient, and immediate-acting analgesic for reducing crying time and significantly decreases biobehavioral pain response following painful procedures with infants.
