DRAWING the LINE at 39: A SYSTEMWIDE APPROACH to REDUCING ELECTIVE BIRTHS BEFORE 39 WEEKS GESTATION
Audio File
- Discuss the risks of elective delivery prior to 39 weeks.
- Describe the obstacles present in attempting to eliminate less than 39 week elective deliveries.
- Define the process used to decrease the elective delivery rate prior to 39 weeks in Centura.
Research has shown that iatrogenic prematurity can often be the result of deliveries prior to 39 completed weeks gestation. The primary goal of was to reduce the incidence of less than 39 week elective births across Centura Health. This has been a long-held national standard set forth by the American College of Obstetricians and Gynecologists, but one that was often ignored.
Proposed change:
Standardized policy (across a 9 hospital system) requiring a maternal or fetal medical indication to support delivery prior to 39 weeks. This was incorporated along with the rest of the IHI induction and augmentation bundle requirements.
Implementation, outcomes and evaluation:
Data was collected at all 9 facilities for rates of both elective inductions of labor as well as elective cesarean deliveries prior to 39 weeks. A multidisciplinary team compromised of Registered Nurses, Obstetricians and Perinatologists was developed to review the data from the Centura facilities and to review the literature regarding guidelines for induction of labor. A new standardized induction of labor policy was developed requiring provider documentation for any delivery planned prior to 39 weeks gestation. OB providers and nurses were educated by nurse and physician perinatal safety champions at all nine facilities. After implementation of the induction of labor policy requiring patients to be >39 weeks gestation, the Centura hospitals realized a reduction from 17% to <1% in elective delivery rates.
Implications for nursing practice:
By following national standards which have found that by not performing elective deliveries less than 39 weeks there will be a lower incidence of iatrogenic prematurity, nurses and providers can contribute to improved quality in obstetric practice. Implementation of these standards is appropriate in a culture increasingly focused on patient safety.
Keywords: Elective inductions, elective births, 39 weeks, iatrogenic prematurity
