改善產房新生兒入住中重度病房低體溫專案

背景：調查單位產房出生轉入的新生兒個案入院後一小時體溫低於36.5℃（低體溫）中有66.7%容易造成生理異常而使死亡率上升，因此了解新生兒體溫變化及適當保暖是照護新生兒極重要的工作。目的：本專案旨在改善新生兒入住單位低體溫現況。解決方案：本專案自2016年10月1日至2017年10月31日間，調查產房轉入新生兒低體溫現狀、提出改善措施為擬定低體溫照護標準、將新生兒入住準備相關用物標準化、製作低體溫警醒標語小卡、海報內容、規劃在職人員在職教育、制定定期查檢表。結果：專案執行後新生兒入住體溫回升至36.5℃平均需1.5小時，較專案執行前提早2小時；依出生體重比較，出生體重≥2,500公克者體溫回升至36.5度需1小時，較專案執行前提早1小時達成；出生體重<2,500公克者體溫回升至正常值需1.5小時，較專案執行前提早3小時，兩組改善成效皆達目標。結論：新生兒出生後的低體溫仍是造成病情改變重要的環節，我們加強改善了照護人員認知，值得持續推行改善於臨床新生兒照護中。 Background & Problems: An investigation found that 66.7% of the neonatal hypothermia (body temperature < 36.5℃) cases diagnosed within one hour of transfer from the delivery room in our hospital were affected by a significantly increased risk of physiological abnormalities, which subsequently increased their risk for mortality. Therefore, monitoring and maintaining the normal body temperature of newborn infants are vital in infant care. Purpose: This project aimed to improve the current situation of neonatal hypothermia. Resolution: This project was implemented from Oct. 1, 2016 to Oct. 31, 2017 and used several approaches to improve neonatal hypothermia. A neonatal hypothermia caring protocol was developed and the infant admission materials were standardized; the infant hypothermia alert card and posters were displayed in easy-to-notice locations; an in-service training course on neonatal hypothermia was provided; and an infant hypothermia care checklist was tabulated for examination and recognition. Results: After the implementation of this project, the average time required to raise the body temperature of infants to normal (36.5℃) was 1.5 hours, which was 2 hours faster than the pre-project time of 3.5 hours. Moreover, the time needed to raise the body temperature to normal was one hour for newborn infants with birthweights ≥ 2,500 grams, which was one hour faster than the pre-project time of two hours, and 1.5 hours for newborn infants with birthweights < 2,500 grams, which was three hours faster than the pre-project time of 4.5 hours. The goals of this project were effectively achieved in both groups. Conclusion: Neonatal hypothermia is an important issue affecting the health status of newborn infants. This project strengthened the awareness of nurses regarding neonatal hypothermia and is worthwhile to be implemented in clinical neonatal care.