Limits...
Current practice of neonatal resuscitation documentation in North America: a multi-center retrospective chart review.

Braga MS, Kabbur P, Alur P, Goodstein MH, Roberts KD, Satrom K, Shivananda S, Goswami I, Pappagallo M, Briere CE, Suresh G - BMC Pediatr (2015)

Bottom Line: Covariates associated with this Assessment were identified.In our model adjusted for measured covariates, the institution was significantly associated with documentation.Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics.

View Article: PubMed Central - PubMed

Affiliation: Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Children's Hospital at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA. matthew.s.braga@hitchcock.org.

ABSTRACT

Background: To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation.

Methods: Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant's record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified.

Results: Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation.

Conclusions: Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation.

No MeSH data available.


Related in: MedlinePlus

Documentation Assessment for Each Institution. Documentation Score = 1 point for mentioning the following items and 0 points if nothing mentioned; Review of OB history, Briefing done, Equipment check, Personnel Check, Apgar at 1 min, description of APGAR at 1 min, Apgar at 5 min, description of APGAR at 5 min, Delivery Room Temperature, Radiant Warmer, Drying of Baby, Exothermic Mattress, Plastic Wrap, Hat, Temperature Measured in Delivery Room, Pulse Oximetry, Supplemental Oxygen, Airway Clearance/Suctioning, Positioning of Airway, Stimulation, Continuous Positive Airway Pressure, Bag Mask Ventilation, Endotracheal Intubation, Heart Rate with Repeated Assessment and Monitoring, Chest Compressions, Umbilical Line Placement, Assessment Intervention Pattern, Family Presence During/After Resuscitation, Communication with Family During/Immediately Post Resuscitation. Total available points = 29
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4647697&req=5

Fig1: Documentation Assessment for Each Institution. Documentation Score = 1 point for mentioning the following items and 0 points if nothing mentioned; Review of OB history, Briefing done, Equipment check, Personnel Check, Apgar at 1 min, description of APGAR at 1 min, Apgar at 5 min, description of APGAR at 5 min, Delivery Room Temperature, Radiant Warmer, Drying of Baby, Exothermic Mattress, Plastic Wrap, Hat, Temperature Measured in Delivery Room, Pulse Oximetry, Supplemental Oxygen, Airway Clearance/Suctioning, Positioning of Airway, Stimulation, Continuous Positive Airway Pressure, Bag Mask Ventilation, Endotracheal Intubation, Heart Rate with Repeated Assessment and Monitoring, Chest Compressions, Umbilical Line Placement, Assessment Intervention Pattern, Family Presence During/After Resuscitation, Communication with Family During/Immediately Post Resuscitation. Total available points = 29

Mentions: The mean (SD) number of items documented in a record was 13.2 (3.5). Figure 1 displays the number of items documented at each participating hospital as box and whisker plots.Fig. 1


Current practice of neonatal resuscitation documentation in North America: a multi-center retrospective chart review.

Braga MS, Kabbur P, Alur P, Goodstein MH, Roberts KD, Satrom K, Shivananda S, Goswami I, Pappagallo M, Briere CE, Suresh G - BMC Pediatr (2015)

Documentation Assessment for Each Institution. Documentation Score = 1 point for mentioning the following items and 0 points if nothing mentioned; Review of OB history, Briefing done, Equipment check, Personnel Check, Apgar at 1 min, description of APGAR at 1 min, Apgar at 5 min, description of APGAR at 5 min, Delivery Room Temperature, Radiant Warmer, Drying of Baby, Exothermic Mattress, Plastic Wrap, Hat, Temperature Measured in Delivery Room, Pulse Oximetry, Supplemental Oxygen, Airway Clearance/Suctioning, Positioning of Airway, Stimulation, Continuous Positive Airway Pressure, Bag Mask Ventilation, Endotracheal Intubation, Heart Rate with Repeated Assessment and Monitoring, Chest Compressions, Umbilical Line Placement, Assessment Intervention Pattern, Family Presence During/After Resuscitation, Communication with Family During/Immediately Post Resuscitation. Total available points = 29
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4647697&req=5

Fig1: Documentation Assessment for Each Institution. Documentation Score = 1 point for mentioning the following items and 0 points if nothing mentioned; Review of OB history, Briefing done, Equipment check, Personnel Check, Apgar at 1 min, description of APGAR at 1 min, Apgar at 5 min, description of APGAR at 5 min, Delivery Room Temperature, Radiant Warmer, Drying of Baby, Exothermic Mattress, Plastic Wrap, Hat, Temperature Measured in Delivery Room, Pulse Oximetry, Supplemental Oxygen, Airway Clearance/Suctioning, Positioning of Airway, Stimulation, Continuous Positive Airway Pressure, Bag Mask Ventilation, Endotracheal Intubation, Heart Rate with Repeated Assessment and Monitoring, Chest Compressions, Umbilical Line Placement, Assessment Intervention Pattern, Family Presence During/After Resuscitation, Communication with Family During/Immediately Post Resuscitation. Total available points = 29
Mentions: The mean (SD) number of items documented in a record was 13.2 (3.5). Figure 1 displays the number of items documented at each participating hospital as box and whisker plots.Fig. 1

Bottom Line: Covariates associated with this Assessment were identified.In our model adjusted for measured covariates, the institution was significantly associated with documentation.Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics.

View Article: PubMed Central - PubMed

Affiliation: Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Children's Hospital at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA. matthew.s.braga@hitchcock.org.

ABSTRACT

Background: To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation.

Methods: Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant's record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified.

Results: Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation.

Conclusions: Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation.

No MeSH data available.


Related in: MedlinePlus