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Sunday, September 26, 2010
Title: Maternity Pre-Admission Program
Discipline: Professional Issues (PI), Newborn (NB), Childbearing (CB), Advanced Practice (AP)
Learning Objectives:
Submission Description:- Describe at least three reasons to develop a pre-admission program.
- Identify three different issues to overcome in the development stage of a pre-admission program and strategies to confront them.
- Identify and describe potential benefits to a pre-admission in your own facility.
Five obstetricians and nine family practice physicians average 130 deliveries monthly in our 29-bed LDRP unit.
Pediatricians and family practitioners expressed frustration with the large number of patients consistently assigned to them during their on-call rotations. We had also experienced repeated problems in receipt/storage of prenatal records from delivering physicians. Unit leadership had already been considering a pre-admission program. Hospital administrators willingly endorsed such a program to help combat both of these physician-related issues.
Planning and fact gathering are necessary steps of change theory (Keith, 2006). Structure for the program was first established. Basic components include a physical space to conduct the visits, a job description and budgeted position, a dedicated phone line and computer access to electronic patient records. Logistic components include a method of identifying patients at defined gestations, transfer of prenatal records to the pre-admission coordinator, a written process of scheduling appointments, conducting and documenting visits, performance improvement tracking and evaluation (Hamilton , 2007).
A chart form was created to document educational items addressed in the visit. An accompanying teaching guideline was developed as an orientation tool for the newly created position. The job description required that the candidate be an obstetric nurse or a certified childbirth instructor so they would be able to address most concerns about the delivery experience. A prenatal breastfeeding assessment tool was also developed to help identify patients that could benefit from advice or intervention from a lactation consultant prior to hospitalization. Multiple resource lists and pamphlets were collated and updated to be readily available during visits for patients with special concerns such as adoption, paternity assignment, multiple gestations, or other discharge planning needs. Hospital consents and other forms were identified for completion during pre-admission visits and listed for reference and creation of pre-admission packets.
The public relations department helped create a flyer for patient distribution in physician offices. The new Pre-Admission Coordinator and the Director and Clinical Nurse Specialist of the maternity department met with physician office managers individually to establish a plan for identifying patients and to explain the goals of the program (Dickinson, 2007). We began the program with patients from the physician group with the highest number of deliveries and added other offices in phases over a period of six months.
Prior to the program’s inception, the rate of infants assigned to the pediatrician on-call was 30%. After six months of a part-time program, the pediatrician on-call rate decreased to 15%. One year after implementing the program and six months following the inclusion of all delivering physicians, the same on-call rate dropped to 11%. Complaints about missing prenatal records are now few and far between. Approximately 65% of all delivering patients are now attending a pre-admission appointment. The position has been increased from a part-time to full-time FTE. Appointment scheduling transferred from the pre-admission coordinator to a centralized scheduling department. The major value of this program is documented in the highly positive evaluations from participants. Patients and nurses appreciate the expedience of completing necessary paperwork upon admission.
Pediatricians and family practitioners expressed frustration with the large number of patients consistently assigned to them during their on-call rotations. We had also experienced repeated problems in receipt/storage of prenatal records from delivering physicians. Unit leadership had already been considering a pre-admission program. Hospital administrators willingly endorsed such a program to help combat both of these physician-related issues.
Planning and fact gathering are necessary steps of change theory (Keith, 2006). Structure for the program was first established. Basic components include a physical space to conduct the visits, a job description and budgeted position, a dedicated phone line and computer access to electronic patient records. Logistic components include a method of identifying patients at defined gestations, transfer of prenatal records to the pre-admission coordinator, a written process of scheduling appointments, conducting and documenting visits, performance improvement tracking and evaluation (
A chart form was created to document educational items addressed in the visit. An accompanying teaching guideline was developed as an orientation tool for the newly created position. The job description required that the candidate be an obstetric nurse or a certified childbirth instructor so they would be able to address most concerns about the delivery experience. A prenatal breastfeeding assessment tool was also developed to help identify patients that could benefit from advice or intervention from a lactation consultant prior to hospitalization. Multiple resource lists and pamphlets were collated and updated to be readily available during visits for patients with special concerns such as adoption, paternity assignment, multiple gestations, or other discharge planning needs. Hospital consents and other forms were identified for completion during pre-admission visits and listed for reference and creation of pre-admission packets.
The public relations department helped create a flyer for patient distribution in physician offices. The new Pre-Admission Coordinator and the Director and Clinical Nurse Specialist of the maternity department met with physician office managers individually to establish a plan for identifying patients and to explain the goals of the program (Dickinson, 2007). We began the program with patients from the physician group with the highest number of deliveries and added other offices in phases over a period of six months.
Prior to the program’s inception, the rate of infants assigned to the pediatrician on-call was 30%. After six months of a part-time program, the pediatrician on-call rate decreased to 15%. One year after implementing the program and six months following the inclusion of all delivering physicians, the same on-call rate dropped to 11%. Complaints about missing prenatal records are now few and far between. Approximately 65% of all delivering patients are now attending a pre-admission appointment. The position has been increased from a part-time to full-time FTE. Appointment scheduling transferred from the pre-admission coordinator to a centralized scheduling department. The major value of this program is documented in the highly positive evaluations from participants. Patients and nurses appreciate the expedience of completing necessary paperwork upon admission.
