Sunday, Sep 26 - Expo Hall Opening
Sunday, Sep 26 - Job Fair
Monday,
Sep 27 - AWHONN's Block Party
Monday, September 27, 2010
: 10:00 AM
Title: One Community Hospital's Journey to Successful Implementation of the IHI's Recommended Perinatal Care Bundles to Improve Patient Safety
Venetian
Audio File
Discipline: Professional Issues (PI), Newborn (NB), Childbearing (CB)
Learning Objectives:
Submission Description:- Discuss the significance of a multi-disciplinary team approach for the successful implementation of process change.
- Illustrate the importance of extensive staff and patient education prior to the initiation of practice change.
- Describe the application of literature recommendations to inpatient practice specifically related to criteria for elective delivery and oxytocin initiation/management using updated terminology.
Background: The purpose of the project was to implement the two perinatal care “bundles” recommended by the Institute for Healthcare Improvement: The Elective Induction Bundle and the Augmentation Bundle. The journey began in fall of 2007 with a physician and nurse workgroup. Their goal was to impact unnecessary NICU admissions due to respiratory morbidity by establishing guidelines to eliminate elective scheduled deliveries <39 weeks. Once successful implementation occurred at our community hospital, our hospital system adopted the policy and positively impacted outcomes at a system level.
In fall of 2008 another multi-disciplinary group convened to review the remaining components of the Elective induction Bundle and create a plan for implementation. Their goal was to establish guidelines for the safe use of Oxytocin and decrease the incidence of tachysystole which has a direct impact on fetal well-being. In our community hospital we have successfully impacted the occurrence of tachysystole in relation to Oxytocin administration and now are moving towards implementation of the bundles at a system-wide level.
Phase One: To eliminate elective scheduled deliveries <39 weeks the work group developed the following plan:
· Develop a policy for elective delivery criteria and scheduling
· Develop a patient education sheet for distribution in the offices
· Letter from neonatologist to obstetricians establishing the policy and rationale for change
· Establish peer review process and criteria for reporting
Phase One Outcomes:
| Community hospital (pilot) | Elective Deliveries (Inductions and Cesarean Sections) <39 weeks | Total Deliveries | Admits to NICU for respiratory distress (deliveries <39weeks) |
| 2007 (prior to implementation) | 107 | 2843 | 5 |
| 2008 (after implementation) | 8 | 2693 | 0 |
| 2009 (January-June) | 1 | 1401 | 0 |
| System 2 additional hospitals (ESJH & EGSMC) | Elective Deliveries (Inductions and Cesarean Sections) <39 weeks | Total Deliveries | Admits to NICU for respiratory distress (deliveries <39weeks) |
| ESJH | |||
| 2008 (implementation-spring) | 107 | 5200 | 6 |
| 2009 (January-June) | 23 | 2458 | 1 |
| EGSMC | |||
| 2008 (implementation-spring) | 12 | 2168 | 0 |
| 2009 (January-June) | 6 | 1084 | 0 |
Phase Two: To establish guidelines for the safe use of Oxytocin and decrease the incidence of tachysystole, the inter-disciplinary work group agreed on the following plan:
· Use the recently published NICHD report on Electronic Fetal Monitoring (September 2008) and the Three-Tier Fetal Heart Rate Interpretation System to update the labor and delivery induction protocol.
· Establish criteria for both pre-induction and Oxytocin management related to fetal heart rate and uterine contraction interpretation.
· Create a pre-induction checklist for use in our computerized documentation system.
· Create a safety checklist to be completed by nurses prior to an increase in Oxytocin
· Create an education tool in the form of a stop-light, integrating the three categories mentioned by the NICHD report.
· Plan extensive education for both our provider and nursing staff related to terminology and induction process.
Phase Two Outcomes:
A total of 42 audits were completed in 2009 (January through June). Of those, in two cases nurses inappropriately increased Oxytocin when there was tachysystole present. For the entire hospital system, there were no elective inductions with Cord pH<7.0 or five minute Apgar score <7.
