The purpose or aim of the program was to dramatically reduce elective deliveries prior to 39 weeks gestation across a healthcare system including 9 delivering hospitals within the Midwest.

 Proposed change:

The proposed change was a systematic, evidence-based, reliable approach to assess and adhere to rationale for elective deliveries consistent with medical necessity. The proposed change would unfreeze the status quo, preparing physicians and nurses to reliably provide safe, evidence-based maternal care. 

Implementation, outcomes and evaluation:

The change process was led by the system-wide OB Practice Committee.  Intentional membership of the committee includes:  facility-based nurses, physicians, and system level nursing representation.  Adoption potential for the change process was systematically evaluated at each facility.  Strategies were designed to respect the voice of each facility while being mindful about fail-proofing the process.  The existing shared governance structure was effectively used as the horizontal and vertical communication vehicle ensuring representation from the bedside to the boardroom.  Early adopters shared barriers and successes to facilitate universal adoption.  Inclusion of outpatient clinics and providers was essential in garnering support for this initiative. 

The OB Practice Committee began policy development with a draft presented in January, 2010.  After conferencing, audit and feedback at the individual unit based level the policy was finalized in March, 2010. Implementation at each hospital was championed by a core group but varied in timing due to unit-based readiness. Evidence based practice guidelines were not negotiated, but specific implementation processes were facility-specific, based on the cultural characteristics of the health care team.  All hospitals achieved policy implementation utilizing purposeful diffusion by May 2010. Initial outcomes of this system-wide practice change included dramatic drops in the number of elective deliveries prior to 39 weeks, but assessment of the extent of adoption and barriers continue.  A system scorecard with sensitive, timely indicators identified through gap assessment provides ongoing opportunities to evaluate use of the evidence based practice policies.

Implications for nursing practice:

Utilizing evidence-based practice guidelines decreases point of care disagreements regarding the appropriate timing of any individual delivery.  This initiative prevents avoidable morbidity and mortality of both mothers and infants.  Purposeful development and integration techniques, communication, feedback, and policy development of the committee provide a framework for sustaining this change.  This shared governance model has created a loop of accountability from bedside provider to system level leaders.

Keywords:

Elective deliveries prior to 39 weeks

Collaborative network

Evidence based practice