Advancing Safe Perinatal Care Practices
Audio File
- Identify at least five quality measures of perinatal care.
- Distinguish nursing’s active participation as essential in promoting accurate reporting and compliance with safe care practices.
- Illustrate how adherence to evidence-based practice promotes clinical excellence, reduces patient harm and can position your facility to be among the top performing hospitals when publicly reporting.
To advance evidence-based guidelines and enhance the safety of care provided to patients to promote transparency and accurate reporting.
Proposed change:
Empower and support nurses to identify deviations and facilitate intervention on behalf of patient safety to successfully promote compliance with established guidelines.
Implementation, outcomes and evaluation:
An induction protocol requiring patients to be a minimum of 39.0 weeks gestation was formally put into practice in April, 2007 and expanded in April, 2008 to include elective repeat cesarian deliveries. Despite the protocol and the evidence supporting limiting elective delivery prior to 39 weeks, patients continued to be scheduled and admitted for induction prior to 39 weeks. In November, 2008 the National Quality Forum (NQF) endorsed >37 and <39 week elective deliveries as a quality indicator of perinatal care which was adopted by the Joint Commission (TJC) for reporting starting April, 2010.
A Departmental Safety Committee was established to monitor and support safe patient care processes. Data was obtained internally to assess the NICU admission rate of electively delivered term newborns prior to 39 weeks. Literature was reviewed for medical indications for delivery prior to 39 weeks and shared with providers. Internal review supported the evidence and the Safety Committee set the expectation that there would be no elective inductions before 39 weeks. Nursing was empowered to identify variances and notify the medical director of Labor & Delivery (L&D) to intervene if a patient <39 weeks gestation was scheduled or admitted for elective induction. Safety First Learning Reports were completed if an event occurred and charts were reviewed. If no medical indication, the case was brought to Peer Review.
Results demonstrate an overall reduction in elective deliveries of 55% from FY01 to FY10. The elective delivery rate >37 and <39 weeks decreased 93% in this same time period with a 73% reduction from FY08 to FY10, bringing compliance with the NQF indicator to 99%. Additional findings include a reduction in Newborn Intensive Care Unit (NICU) admissions of electively delivered neonates (75%). Limiting the population to just the electively delivered >37 and <39 week electively delivered newborns demonstrates a reduction to NICU of 88.5% from FY01 – FY10.
Implications for nursing practice:
Empowering and supporting nursing is essential to promote safe patient care practices. Making issues transparent and providing consistent feedback is essential to effect change. Continued monitoring and feedback is critical to ensure accuracy of data and sustained improvement.
Keywords:
Perinatal Quality Indicators, Empowering nurses, Patient safety
