To ignite a passion in nurses to actively engage and participate in performance improvement initiatives that advance evidence-based practices.

Proposed change:

Nurses will commit to participate in on-going performance improvement initiatives with renewed confidence from gained knowledge.

Implementation, outcomes and evaluation:

In 2006, concern was raised by our neonatology department that all women at-risk of preterm delivery were not receiving antenatal steroids. A team of nurses, physicians, and system analysts routinely met to evaluate performance and assess for improvement opportunities. From calendar year 2005, findings from our Neonatal Information System (NIS) showed 77.8 % received at least one dose of antenatal steroids of the women who delivered between 24 – 32 weeks gestation 2005. Staff was educated and protocols established with some improvement (83.9% in CY08) realized. Efforts to develop a KPI (Key Performance Indicator) to facilitate concurrent review of missed opportunities were initiated. In 2009, the National Quality Forum (NQF) released the Perinatal Consensus Standard (PC03) supporting the National Institutes of Health (NIH) recommendations to give a full course of corticosteroids to all expectant women between 24 and 32 weeks gestation. On further evaluation, numerous challenges surfaced including the collection and accurate reporting of data (due to definitional issues of successful treatment), identification of barriers to treatment, and the need to clarify reporting parameters. The need to refine the definition of success (to accurately measure quality within the constraints of controllable variables) was also identified. In October, 2010, the KPI was operationalized; facilitating concurrent review of identified cases of failed treatment. Staff education and awareness of the need for timely administration (within 2 hours of admission/order) was established.

Utilizing the PDCA (Plan-Do-Check-Act) continuous performance improvement (CPI) model, the percentage of mother’s receiving antenatal steroids prior to delivering a premature newborn improved 19%, from 78% to 93% between 2005 and 2010 (per the NIS data base). Additional improvements were realized with the use of the KPI, correcting and supplementing the system’s reporting capabilities, specific to the NQF definition (successful treatment defined as administration of both doses administered). Monthly rates improved from 61.5% in Oct, 2010 to 100% in July, 2011. A 38.5% increase!  

Implications for nursing practice:

It is essential to set clear expectations and involve front line staff in promoting evidence-based practices. PDCA is a valuable tool to guide and sustain quality improvement endeavors.   

Keywords:

Antenatal Steroids, Perinatal Quality Indicators, PDCA, Empowering nurses, Performance Improvement