降低低體重早產兒低體溫發生率

研究顯示，出生一小時內體溫低於36°C是新生兒死亡的高危險因子，體溫每降低一度，則會增加28%的死亡率，低體重早產兒若發生低體溫，更增加併發症與死亡率風險，故維持新生兒體溫穩定、避免低體溫是非常重要的。本案旨在降低低體重早產兒低體溫發生率，分析發現：低體重早產兒低體溫發生率高之主因為：產房室溫太低、醫療團隊角色分工不清楚、醫療人員對於預防早產兒低體溫的做法不熟悉與不一致、預防早產兒低體溫相關教育訓練與宣導不足。改善措施：提高新生兒處理台周圍及運送路線的環境溫度、舉辦團隊資源管理訓練課程、錄製教學影片、建立並實施流程查檢表與備物套裝化、舉辦在職教育以加強相關訓練、醫護相關會議建立標準作業流程及加強宣導，並依臨床現況修訂預防早產兒低體溫流程照護標準，加強查核新進護理之臨床照護，且列為單位品管計畫。結果：「離開產房前低體溫發生率」改善前平均58.8%，下降至改善中41.7%、改善後5.9%；入住加護病房一小時內低體溫發生率」改善前平均82.4%，下降至改善中41.7%、改善後5.9%，有效降低低體重早產兒低體溫發生率及提升照護品質。 Hypothermia of very low birth weight (VLBW) preterm babies is associated with increased morbidity and mortality. Maintenance and stabilization of adequate body temperature are vital in this patient population. In this program, we aimed to reduce the incidence of hypothermia in VLBW preterm babies. Investigations showed that the major reasons of the high incidence of hypothermia in this institution included a low-temperature environment of the delivery room, unclear roles, and responsibilities among medical team members, unfamiliarity with the process of preventing hypothermia, insufficient education training and advocacy, and lack of standardized procedure to prevent hypothermia. Improvement strategies included maintenance of higher temperatures surrounding the infant and the transportation route, the provision of Team Resources Management (TRM) training with teaching video, establishment and implementation of a process checklist and prepared kit materials, ongoing education and training, establishment of standardized operation procedures according to current clinical situation, and intensified auditing of the clinical care process of the nurses. The results showed that the incidence of hypothermia before the neonate was leaving the delivery room has improved from 58.8% to 41.7% after the starting of improvement and then even lowered to 5.9% during the post-implementation period. The incidence of hypothermia in the first hour after admission to the neonatal intensive care unit was reduced from 83.3% to 41.7% during improvement and was 5.9% during the post-implementation period. We conclude that the implementation of these strategies in this program reduced the incidence of hypothermia in VLBW newborns effectively and improved the quality of care.