Onderzoek & publicaties

Escalating global nursing shortages require solutions for efficient care, fewer injuries and lost workdays. When commercial solutions are lacking, innovations developed through co-creation can be a viable alternative. However, many co-created nursing innovations are ineffectively implemented. Understanding the barriers and facilitators for the successful implementation of co-created nursing innovations is crucial.

Compliance with the recommended 30 s drying time of alcohol-based hand rub (ABHR) is often suboptimal. To increase hand hygiene compliance at a neonatal intensive care unit (NICU), we installed an Incubator Traffic Light (ITL) system which shows 'green light' to open incubator doors after the recommended drying time.

Nurses frequently innovate in response to operational failures, regulations, procedures, and/or other workflow barriers that prevent them from delivering high-quality patient care. Unfortunately, most nurse innovations do not diffuse to a broader audience, depriving other nurses from taking advantage of solutions that have already been developed elsewhere. This under-diffusion is problematic from a societal and welfare point of view. The goal of this paper is to understand how diffusion shortage of nurse innovations can be reduced.

User innovations are often valuable to other people, but fail to diffuse because users lack incentives to do a dissemination effort. Past research recognized that users sometimes spur diffusion themselves, and that producers may search for and commercialize user innovations. In this study we identify a third type of actor who fills the void between initial solution and broad dissemination - without being a potential user or commercial diffuser himself. We document a case study at an academic hospital where workers created and institutionalized a system to support and disseminate user innovations developed by nurses. They proactively created a network with makerspace facilities, without being asked or instructed to do so. These workers fulfilled a disseminator role: they continued to develop user innovations to make adoption easy, explored commercial pathways, mobilized peer demand, and created favorable project conditions. Interestingly, the diffusion system was institutionalized by job crafting, securing budgets, embedding diffusion activities in the organization chart, and developing strategic relationships. Disseminators were motivated by self-actualization, enjoyment, reputation advancement, and altruism towards the nursing community; they strived to become ‘heroes of diffusion’. We conclude that a disseminator role in-between user innovators, and peer adopters and commercial producers, represents an alternative mechanism for user innovations to spread widely, and opens opportunities for new research.

In innovatielabs lossen verpleegkundigen, studenten en technici problemen uit de ziekenhuispraktijk op met zorgtechnologie. Medische centra en hogescholen hebben hiertoe de handen ineengeslagen. Verpleegkundigen worden vaak geconfronteerd met praktische problemen die ze tijdelijk oplossen via ‘houtje-touwtje-constructies’. Maar de problemen kunnen ook structureel worden aangepakt met behulp van technologie. In innovatielabs nemen verpleegkundigen het voortouw bij het ontwikkelen van zorginnovaties. Het Verpleegkundig Platform Zorginnovatie Nederland, een samenwerkingsverband tussen ziekenhuizen en hogescholen, versnelt de impact van deze bottom-up-aanpak. De innovatiekracht van verpleegkundigen staat hierbij centraal.

Verpleegkundigen komen regelmatig onhandige en onveilige werkprocessen tegen. Die nemen ze vaak voor lief - 'We hebben het altijd zo gedaan' - of ze improviseren iets. Create4Care ontwikkelt samen met hogeschoolstudenten van diverse opleidingen definitieve oplossingen. Sinds 2013 ontwikkelt ontwerpstudio Create4Care in het Erasmus MC zorg- innovaties. Dat gebeurt op basis van suggesties van verpleegkundigen die hun werkprocessen willen verbeteren of voor meer comfort van patiënten willen zorgen.¹ Voor de ontwikkeling van zorginnovaties is het Create4Care- proces ingericht. Dit is tevens een kapstok voor het managen van het ontwikkel- en productieproces. Create4Care werkt als een ondernemend ontwerpbureau, dat voldoet aan kwaliteitseisen. Behalve een ontwerpstudio, uitgerust om de eerste prototypen te maken, is er begeleiding door ontwerpers voor de (technische) ontwikkelkant en zijn adviseurs aanwezig voor de begeleiding bij implementatie, evaluatie, dossieropbouw en verspreiding.

Introduction Growth monitoring of preterm infants is essential for assessing the nutritional effects on their growth. The current growth monitoring techniques are too stressful, however, for the smallest preterm infants. We performed a systematic review to summarize studies on stress-free techniques for measuring the body size of preterm infants inside incubators other than the traditional calliper and tape measure-based instruments. Methods We searched four online literature databases: Embase, Medline, Web of Science Core Collection, and Cochrane, using search terms related to patients (neonates, infants, children) and body size measuring techniques. By means of expert judgement we assessed the techniques’ suitability for stress-free body size measurement of an infant lying in an incubator. As a criterion for suitability, we used an imaginary ideal technique. Results Twenty-six studies were included in this review. In 24 studies, the technique for body size measurement was related to 3D technology, and the majority of these studies acknowledged clinical superiority of 3D over 2D data. Two 3D techniques were assessed as suitable for stress-free measurement of preterm infants inside incubators. The first technique used a commercially available 3D handheld scanner which needed 3D postprocessing to derive measurement data. The second technique used a self-developed stereoscopic vision system. Conclusions 3D volumetric parameters have higher clinical value for growth monitoring than 2D. In addition, contactless 3D measurements enable stress-free growth monitoring of even the smallest preterm infants. However, the time-consuming 3D postprocessing challenges the usability of 3D techniques. Regrettably, none of the identified suitable 3D techniques met all our requirements of an ideal all-in-one body size measuring technique for extreme preterm infants. Handheld 3D scanning might have the best properties for developing this ideal technique.

Preterm infants, cared at Neonatal Intensive Care Units (NICU’s), require optimal growth for best short- and long-term neuro-developmental outcomes. Unfortunately, measuring body length (BL) or head circumference (HC) with commonly used technique scan be so stressful for preterm infants that measurements are skipped to prevent stress-related adverse events.

Onno Helder is de eerste verpleegkundig leider met een 'eigen' zorginnovatie-afdeling in een universitair medisch centrum. Waarom is de zorginnovatie-afdeling opgezet? 'Verpleegkundigen komen in hun dagelijkse werk vaak praktische problemen tegen die ze zelf provisorisch oplossen. Create4Care is een door mij geïnitieerde nieuwe afdeling binnen het Erasmus MC waar slimme technische zorg- of procesinnovaties worden ontwikkeld en getest.

Novel techniques for body size measurement of preterm infants lying in incubators. Through co-design with NICU healthcare professionals of the Erasmus MC-Sophia Children’s Hospital, students of the Rotterdam University of Applied Sciences and industry partners, we develop functional prototypes of novel ‘touchless’ measuring instruments, going from 1D to 3D technology.

The use of antiseptic barrier caps reduced the occurrence of central line-associated bloodstream infections (CLABSI) in adult intensive care settings. We assessed the effect of the use of antiseptic barrier caps on the incidence of CLABSI in infants and children and evaluated the implementation process. Methods: We performed a mixed-method, prospective, observational before-after study. The CLABSI rate was documented during the "scrub the hub method" and the antiseptic barrier cap phase. Main outcomes were the number of CLABSIs per 1,000 catheter days (assessed with a Poisson regression analysis) and nurses' adherence to antiseptic barrier cap protocol. Results: In total, 2,248 patients were included. The rate of CLABSIs per 1,000 catheter days declined from 3.15 to 2.35, resulting in an overall incidence reduction of 22% (95% confidence interval, -34%, 55%; P = .368). Nurses' adherence to the antiseptic barrier cap protocol was 95.2% and 89.0% for the neonatal intensive care unit and pediatric intensive care unit, respectively. Discussion: The CLABSI reducing effect of the antiseptic barrier caps seems to be more prominent in the neonatal intensive care unit population compared with the pediatric intensive care unit population. Conclusions: The antiseptic barrier cap did not significantly reduce the CLABSI rates in this study.

Mechanical ventilation is one of the most commonly used treatments in neonatology. Prolonged mechanical ventilation is associated with deleterious outcomes. To reduce the ventilation duration, weaning protocols have been developed to achieve extubation in adult and pediatric care in a safe and uniform manner. We performed a systematic review to obtain all available evidence on the effect of protocolized versus nonprotocolized weaning on the duration of invasive mechanical ventilation in critically ill neonates. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Web of Science, and the International Clinical Trial Registry Platform were searched until January 2018. Quantitative and qualitative studies involving neonates that investigated or described protocolized versus nonprotocolized weaning were included. Primary outcome was the difference in weaning duration. A total of 2099 potentially relevant articles were retrieved. Three studies met the inclusion criteria. Of 2 of these, the separate neonatal data could not be obtained. Only one retrospective study was included for this review. This reported a decrease in the mean weaning time from 18 to 5 and 6 days, respectively. There is no robust evidence in the literature to support or disprove the use of a weaning protocol in critically ill neonates.

Introduction Sustained high compliance with hand hygiene prior to patient contact in a neonatal intensive care unit (NICU) could reduce the spread of pathogens and incidence of bloodstream infections of preterm infants. These infections are associated with high mortality, morbidity and additional costs. Behaviour change interventions to promote hand hygiene, such as education, have only temporary beneficial effect on compliance. Our aim is to develop a technical intervention that supports a sustainable behaviour change for appropriate hand hygiene among NICU healthcare professionals. Methods Students from different disciplines incrementally designed and evaluated solutions in co-creation with healthcare professionals of a NICU in a teaching hospital. Results A prototype of the ‘Incubator Traffic Light’ system for neonatal incubators was developed, that is, a touchless alcohol-based hand rub (ABHR) dispenser with integrated colour display and incubator door sensor with lights. The system provides visual feedback to support healthcare professionals’ compliance with the prescribed 30 s drying time for ABHR. After 30 s, green lights indicate that the incubator doors may be opened. In the event that doors are opened without dispensing ABHR or earlier than 30 s, blinking orange lights and a display message urge the person to close the doors. The system documents compliance data in a web-based database. Conclusions We developed a sophisticated technical intervention to support hand hygiene compliance. It is ready for clinical tests that should prove that the system contributes to sustainable hand hygiene compliance near neonatal incubators.