Revising acute care systems and processes to improve breastfeeding and maternal postnatal health a pre and post intervention study in one English maternity unit 英文参考文献.docVIP

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Revising acute care systems and processes to improve breastfeeding and maternal postnatal health a pre and post intervention study in one English maternity unit 英文参考文献.doc

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Revising acute care systems and processes to improve breastfeeding and maternal postnatal health a pre and post intervention study in one English maternity unit 英文参考文献

Bicketal.BMCPregnancyandChildbirth2012,12:41 /1471-2393/12/41 RESEARCH ARTICLE OpenAccess Revisingacutecaresystemsandprocessesto improvebreastfeedingandmaternalpostnatal health:apreandpostinterventionstudyinone Englishmaternityunit DebraBick1*,TrevorMurrells1,AnnetteWeavers2,ValRose2,JulieWray3andSarahBeake1 Abstract Background:MostwomenintheUKgivebirthinahospitallabourward,followingwhichtheyaretransferredtoa postnatalwardanddischargedhomewithin24to48hoursofthebirth.Despitepolicyandguideline recommendationstosupportplanned,effectivepostnatalcare,nationalsurveysofwomen’sviewsofmaternitycare haveconsistentlyfoundin-patientpostnatalcare,includingsupportforbreastfeeding,ispoorlyrated. Methods:UsingaContinuousQualityImprovementapproach,routineantenatal,intrapartumandpostnatalcare systemsandprocesseswererevisedtosupportimplementationofevidencebasedpostnatalpractice.Toidentifyif implementationofamulti-facetedQIinterventionimpactedonoutcomes,dataonbreastfeedinginitiationand duration,maternalhealthandwomen’sviewsofcare,werecollectedinapreandpostinterventionlongitudinal survey.Primaryoutcomesincludedinitiation,overalldurationanddurationofexclusivebreastfeeding.Secondary outcomesincludedmaternalmorbidity,experiencesandsatisfactionwithcare.Asmostoutcomesofinterestwere measuredonanominalscale,thesewerecomparedpreandpostinterventionusinglogisticregression. Results:Datawereobtainedon741/1160(64%)womenat10dayspost-birthand616(54%)at3months post-birthpre-intervention,and725/1153(63%)and575(50%)respectivelypost-intervention.Postintervention therewerestatisticallysignificantdifferencesintheinitiation(p=0.050),durationofanybreastfeeding(p=0.020) anddurationofexclusivebreastfeedingto10days(p=0.038)anddurationofanybreastfeedingtothreemonths (p=0.016).Postintervention,womenwerelesslikelytoreportphysicalmorbiditywithinthefirst10daysofbirth, andweremorepositiveabouttheirin-patientcare. Conclusions:Itispossibletoimproveoutcomesofroutinein-patientcarewithincurrentresourcesthrough continuousq