544 / Avoiding complications and increasing survival rate in Syndrome of Respiratory Distress by Surfactant Deficiency

ROMANIA
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Early warning
Infection control / Prevention of surgical site infections There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
In the neonatal intensive care unit, an important category of patients is the premature newborn, which could be a critical patient when he has a surfactant deficiency and other disorders related to adaptation to extra uterine life.

Syndrome of Respiratory Distress by Surfactant Deficiency SRDSD is the leading cause of morbidity and mortality that occurs mainly in premature infants with gestational age (GA) below 32 weeks. Before introducing antenatal corticosteroids treatment and postnatal treatment with surfactant, SRDSD prevalence was 2-3% of infants living in Europe. Subsequently dropped to 1-1.5%.

Our procedure is aimed to maximize the survival rate of infants with SRDSD and decrease the morbidity due to complications and side effects of treatment by applying standardized diagnostic criteria and best medication and supportive respiratory techniques as stipulated in internal protocol for management of SRDSD
Description of the Patient Safety Practice
 
The medical intervention for assisting new borne with respiratory distress by lack of surfactant is requiring a very well trained and good cooperation teamwork in order to stabilized and support a week and high risk patient.

Tools for implementation the practice to increase the survival rate of the new borne with respiratory distress by lack of surfactant:

Good lab facilities, high tech equipment and a modern ward
Multidisciplinary team and well train staff – gynecologist, neo-natal intensive care, specialist,
mid-wives and nurses with clear responsibilities
Application of protocols for care
Advances skills for special maneuvers

The main priorities are: early intervention, supporting vital parameters, using specific therapy, short and long term monitoring

Identification of the risk patients and early diagnosis:
-Identify anamnestic risk factors for SRDSD of the premature newborn from the moment of birth and establish immediate postnatal period (4-6 hours)
- Conduct set of clinical examination, radiological and laboratory needed for diagnosis
Responsible: neonatologist at the delivery room / doctor on call, nurse

Early treatment
-Maneuvering and specific treatment to stabilize breathing, breath control, using specific equipment
Responsible: the doctor treating neonatologist / guard and assistance

Prophylactic surfactant and early curative:
-Start the surfactant administration in all cases provided the procedure (taking into account specific clinical indicators)

Oxygen administration (invasive and noninvasive mechanical ventilation):
- Start the respiratory support as is required in all the cases and conditions specified by the procedure

Supportive treatment:
-Keep constant temperature of the body, balance hydration and nutrition, blood pressure, antibiotics, preventing chronic lung disease.

Short-term monitoring
-Follow up the health indicators (PaO2, temperature, pulse, BP, diuresis, weight) and cardiorespiratory stability.

Long term monitoring
-Establish a plan for follow up with the support of a multidisciplinary team: neurologist, ophthalmologist, lung specialist for follow-up neuro-motor development, retina status, vaccination to avoid the risk for respiratory syncitial virus, according to the national guidelines.

Our clinic is serving 15-18% preterm births annually (under 37 weeks gestation); 2.25% are under 32 weeks gestational age. About half of them have indications and are receiving exogenous surfactant early therapy as stated above. We have very good results regarding the survival rate decrease of complications.





Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
No
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Hospital
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple specialities across different health care settings
Involved health care staff
 
Physicians
Nurses
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Point of time in which service user or their reprasentatives' involvement takes place
During implementation of the Patient Safety Practices
During evaluation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
Yes
Short description of the service users' level of involvement
Consultation, such as asking for information
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Yes
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Equipment was enhanced or new
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Monika Rusneac
Country: ROMANIA
Organisation: Emergency Clinical Hospital Targu Mures
E-mail: monika.rusneac@yahoo.com
Phone: There is no specified text here
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