Is She or Isn't She In Preterm Labor: Implementing Standardized Assessment
- Identify the key steps in implementing and evaluating the Preterm Labor Asssessment Toolkit in your hospital
- Describe how implementing standardized protocols and clinical algorithms for preterm labor assessment can improve consistency in clinicians’ decision making and increase appropriate disposition decisions
- Assess how the Preterm Labor Assessment Toolkit can be utilized as a quality improvement initiative at your hospital
The Preterm Labor Assessment Toolkit (PLAT) is an evidence-based toolkit designed to standardize the assessment and disposition of patients presenting with the signs and symptoms of preterm labor. PLAT uses an algorithm to evaluate status of membranes and cervical change to determine whether or not a woman is in active preterm labor. It also provides the hospital with sample order sets, nursing education and competency checklists for sterile speculum exams, and a PowerPoint presentation for use in staff education. PLAT was developed in collaboration with Sutter Medical Center, Sacramento and a workgroup of California health professionals in response to a statewide assessment of maternity hospitals which revealed a lack of consistent practice and protocols. It is supported by the Society for Maternal Fetal Medicine and endorsed by ACOG District IX/California.
Proposed change: Over 45 California hospitals have implemented PLAT. Full rollout is defined by: 1) Identification of MD and RN champions in the hospital, 2)Adoption of PLATas a quality improvement initiative , 3) Establishment of maternal transport process, 4) Development or revision of written preterm labor assessment protocol and MD order set, 5) Acquisition of necessary lab equipment,6) Education and training of MD/RN staff on new protocol and process, and 6) Utilization of preterm labor patient education materials.
Implementation, outcomes and evaluation: From 2008-2010, March of Dimes initiated an evaluation of the effectiveness of PLAT in improving clinicians’ patient assessment behaviors and disposition decisions. Evaluation employed qualitative and quantitative methods, including: 1) pre and post-implementation questionnaires to describe hospital policies and procedures and clinical practice and 2) pre and post-implementation chart audits to assess practice change and identify opportunities for improvement Chart audit data was coded for eight clinician decision points that define PLAT compliance (e.g., initial sterile speculum exam, assessment of cervical status and cervical change, and appropriate disposition decision based on completed cervical change assessment). Since clinician behavior change takes repetition and reinforcement, we expect to see greater change in decision points over time. Our plans for the future are to implement a 1 year post-implementation follow-up audit to assess progress and utilize outcomes and lessons learned to revise PLAT in 2011.
Implications for nursing practice: Initial analysis of 10 hospitals has shown favorable impact of PLAT on clinicians’ behaviors, including (but not limited to)a statistically significant (p ≤ .05) increase in compliance with key decision points such as use of sterile speculum exam, assessment of cervical change, and appropirate disposition decision based on cervical change assessment.
Keywords: Preterm labor, preterm, assessment, algorithm, triage
