FOCUS-PDCA: One Hospital's Initiative to Improve HIV Testing Rates In Pregnant Women
- Verbalize the nine steps of FOCUS-PDCA
- Discuss how a multidisciplinary team can use a systematic process to ensure HIV testing is completed prior to delivery
- Apply the FOCUS-PDCA to a performance improvement project in a healthcare facility
Proposed change: Use FOCUS-PDCA to improve % of patients having current HIV testing at time of delivery
Implementation, outcomes and evaluation:
MCGHealth Labor and Delivery began performing blood rapid HIV testing in January 2008. This testing was done on patients who presented to triage on in labor with no prenatal HIV results on their chart. In January 2008, approximately72% of our patients had early pregnancy HIV testing and no third trimester testing.
In September 2008, the American College of Obstetricians and Gynecologists released a Committee Opinion recommending repeat conventional or rapid HIV testing during the third trimester in areas of HIV prevalence which includes the state of Georgia. ACOG also recommends repeat third trimester screening healthcare institutions where prenatal screening identifies at least one HIV infected pregnant woman per 1000 women. In May 2009, the Pediatrics Infectious Disease Section at the Medical College of Georgia recommended that all pregnant women have HIV testing within four weeks of delivery to better identify mothers and newborns who would require antiretroviral therapy during the labor process and newborn period.
In order to be incompliance with the HIV testing recommendations in the third trimester, the FOCUS-PDCA process was implemented. Key components that occurred at the unit level included switching from blood to oral rapid testing and educating bedside staff about the perinatal transmission of HIV. Results of data audits were shared with bedside staff and our multidisciplinary Perinatal Quality Council. The gold standard for HIV screening is 100% compliance; however, our unit’s compliance rate ranged from 79% to 93% from September 2009 to February 2010. Subsequently, our performance improvement initiative continued including sharing of data at monthly Perinatal Quality Council, Perinatal Unit Performance Improvement Council and Perinatal Unit Staff meetings. A dialogue was also begun with our Women’s Health (Clinic) staff.
Implications for nursing practice: This process can be applied to any PI project
Keywords: FOCUS-PDCA, rapid HIV testing, quality improvement
